Patients often ask great questions with very personal feelings. What I mean is that history and math professors may get great questions but a student is less anxious over what the answer might be. One of the best parts of being a doctor is explaining something to a patient about their body. It can mean encouragement from great fear to relief or bringing comfort and illumination to a challenging outlook of injury. We care about what is happening to our body.
A patient recently told me: "I had a MRI last week and got the results today. I have a herniated disk, and arthritis. I am being referred to a specialist. I guess what is your take on both of those? I was in such shock when they told me the news I couldnt comprehend anything they were saying."
I've spoken about the value of xrays before (http://bit.ly/b0hhcX), and I would speak of MRI testing similarly. These tests are valuable tools when utilized to support an overall clinical picture. They are often misleading and unhelpful tools for pain. As the New York Times recently offered, "magnetic resonance imaging seldom sheds light -- indeed, in many studies the scans have picked up spinal abnormalities in many people who have never reported back pain" (http://nyti.ms/eENwWu). Unfortunately, many physicians will see an MRI report with degenerative changes and refer to a specialist for significant interventions (surgery, narcotic medications, injections) when prevention would be more productive to the patient.
Doctors are often driven to interventions while patients would more often benefit from preventions or restorative care. Our health care system does not incentivize preventative medicine nor is there a reward for saving patient's time and money. Our system promotes number and frequency of treatments, the costlier to the patient, the better for the industry. What would happen if a doctor was paid from the overall health of their patients or how much activity the patients were able to enjoy in a year? What a dream that might be!
When a patient hears "degenerative disc disease", "arthritis", "herniated discs", "misalignment", "subluxations", and other less helpful, common diagnoses, I would encourage a response of "what treatment is best for my body?". A patient needs to ask, "What is most likely to restore my ability to move and live?". The momentum of research indicates for low back pain: surgery, drugs, and bed rest are least likely to help while physical therapy, soft-tissue therapy, chiropractic techniques, and rehabilitative exercises are far more productive, safer, and less costly.
In meeting the reality of our system today, patients cannot change economic forces behind surgery and pharmaceutical medicine, but each can ask their physician, "what is the safest and most productive option for my body?"
Thursday, December 30, 2010
Sunday, October 17, 2010
Value of a physical exam
The physical exam is a dying art in medicine. Patients know this; you may have waited longer in the waiting room or filling out forms than your doctor took to examine your condition. There is much evidence to the value of a doctor taking the time to fully examine your body and talk with you to discover what the best course of treatment might be.
A recent article: http://nyti.ms/aGv0m4, from the New York Times, which shares Dr. Verghese's work at Stanford medical school. As a professor, I encourage my students to spend time and effort with a thoughtful history--making a great effort to listen to a patient. A proper exam requires time not just for talking but also for inspection, palpation, range of motion, orthopedic, and neurologic testing. 'Time' is the key. It is not possible to consider most conditions in 20 minutes.
In practice, at Tri-Synergy Chiropractic, we reserve 90 minutes for new patient visits. We've found the best care we can offer takes between 60-90 minutes. We average 2-3 visits per patient with fully successful outcomes because we take the time to listen to a patient, ask key questions, and examine their body before we conclude how we might help.
The pressure other physicians feel to finish a pt visit in 15-20 minutes leads to higher use of MRI, xray, and other expensive testing, without improved healing outcomes. This also leads to a quick prescription mentality, that encourages patients to "take two of pills and call me in a week" instead of assessing the underlying problem. There is a great value in technology, but it will never replace the importance of a physician listening and touching their patient.
A recent article: http://nyti.ms/aGv0m4, from the New York Times, which shares Dr. Verghese's work at Stanford medical school. As a professor, I encourage my students to spend time and effort with a thoughtful history--making a great effort to listen to a patient. A proper exam requires time not just for talking but also for inspection, palpation, range of motion, orthopedic, and neurologic testing. 'Time' is the key. It is not possible to consider most conditions in 20 minutes.
In practice, at Tri-Synergy Chiropractic, we reserve 90 minutes for new patient visits. We've found the best care we can offer takes between 60-90 minutes. We average 2-3 visits per patient with fully successful outcomes because we take the time to listen to a patient, ask key questions, and examine their body before we conclude how we might help.
The pressure other physicians feel to finish a pt visit in 15-20 minutes leads to higher use of MRI, xray, and other expensive testing, without improved healing outcomes. This also leads to a quick prescription mentality, that encourages patients to "take two of pills and call me in a week" instead of assessing the underlying problem. There is a great value in technology, but it will never replace the importance of a physician listening and touching their patient.
Thursday, July 29, 2010
Nagging Injuries
this is a blog I wrote for a great site: www.whywetri.net
the site has some great resources for amateur and professional triathletes
Return from Injury: the missing step
Injuries can be very frustrating. You’d like to train yet your body is letting you down. Diagnosis is the first step. Healing may include therapy, ice/heat, and medication. I hope you’re looking to rehab from the start to expedite your return to activity. We’re going to look at a missed step in return to activity that may be holding you back from racing your full potential.
Rehab is crucial for recovery. Even for surgical repair, studies have highlighted the value of not only rehab but pre-habilitation. For ACL repairs, up to 90% decrease in recovery time was shown with athletes who started rehabbing even before the surgery.
When rehabbing an injury, you want to remember a crucial order of events:
(1) Range of Motion
(2) Control
(3) Strength.
It’s important not to get ahead of yourself with rehab. Too often I hear suggestions from therapists and athletes that an injury would have been prevented if the area was stronger. Ankle or knee sprains are not usually caused by weakness but by the control of the joint. Hip injuries have less to do with weak muscles, but more often a need to resolve the timing and control the brain has over this complex joint. Even more surprising, significant injuries can occur within normal ranges of motion, even when a joint that is wrapped and braced.
In the case of injury, the joint or tissue should be assessed for structural integrity and range of motion first. Of course, you wouldn’t only rehab a detached biceps tendon. Once you have structural integrity and full, optimal movement of that joint, the next step is control not strengthening. The brain needs to be able to stabilize and move the area appropriately before adding additional force of muscle building. Gentle strength improvement is often a gift of chasing stability. Consider using an unstable surface post ankle sprain: this would encourage the brain to learn to control unexpected motions at the joint. Simply doing calf raises may strengthen the joint when the brain expects challenge, but does not focus on the cause of the injury: an unexpected change in forces.
For any injury you’re looking to move past, focus on full range of motion first. Treating scar tissue, adhesions, and painful trigger points is appropriate at this stage. Follow with a chase toward greater stability than you’ve had before, and finally, consider strengthening the area in a functional way.
the site has some great resources for amateur and professional triathletes
Return from Injury: the missing step
Injuries can be very frustrating. You’d like to train yet your body is letting you down. Diagnosis is the first step. Healing may include therapy, ice/heat, and medication. I hope you’re looking to rehab from the start to expedite your return to activity. We’re going to look at a missed step in return to activity that may be holding you back from racing your full potential.
Rehab is crucial for recovery. Even for surgical repair, studies have highlighted the value of not only rehab but pre-habilitation. For ACL repairs, up to 90% decrease in recovery time was shown with athletes who started rehabbing even before the surgery.
When rehabbing an injury, you want to remember a crucial order of events:
(1) Range of Motion
(2) Control
(3) Strength.
It’s important not to get ahead of yourself with rehab. Too often I hear suggestions from therapists and athletes that an injury would have been prevented if the area was stronger. Ankle or knee sprains are not usually caused by weakness but by the control of the joint. Hip injuries have less to do with weak muscles, but more often a need to resolve the timing and control the brain has over this complex joint. Even more surprising, significant injuries can occur within normal ranges of motion, even when a joint that is wrapped and braced.
In the case of injury, the joint or tissue should be assessed for structural integrity and range of motion first. Of course, you wouldn’t only rehab a detached biceps tendon. Once you have structural integrity and full, optimal movement of that joint, the next step is control not strengthening. The brain needs to be able to stabilize and move the area appropriately before adding additional force of muscle building. Gentle strength improvement is often a gift of chasing stability. Consider using an unstable surface post ankle sprain: this would encourage the brain to learn to control unexpected motions at the joint. Simply doing calf raises may strengthen the joint when the brain expects challenge, but does not focus on the cause of the injury: an unexpected change in forces.
For any injury you’re looking to move past, focus on full range of motion first. Treating scar tissue, adhesions, and painful trigger points is appropriate at this stage. Follow with a chase toward greater stability than you’ve had before, and finally, consider strengthening the area in a functional way.
Tuesday, June 15, 2010
How do your muscles get stronger?
What happens to our muscles when we get stronger?
Highlights:
A friend, Samantha, recently asked me what the difference is between a weak and strong person's muscles. I think it's a neat question. Especially because of how dynamic the answer may be. An initial guess is that you add more muscle tissue--and this is correct, but there's so much more! When we discover the ways muscles strengthen, we can learn how to maximize our power and health.
Muscle action explained in 30 seconds...go!
Muscles on a functional level are made of overlapping protein fibers (eg actin & myosin). When a nerve signal fires, the muscle tissue is flooded with a watery bath of ions (kind of like gatorade :) which causes the protein fibers to play a game of tug-of-war. The winner is you--and your now contracted muscles. And scene!
An increase in the number of the protein filaments (myofibrillar hypertrophy) is not always shown in thickness or bulk of the individual. This is what I call "dad strength", where my father was always lean yet could battle 2 growing boys with ease. This is also encouraging to women who are looking to add strength or calorie-burning potential without adding significant bulk.
You can add strength, especially endurance without any physical change to the number or size of muscle fibers. Through good nutrition and exercise, you may increase the power plants in your cells that provide muscles with energy to work. The more often you work your muscles, the more you're telling your body to make little energy factories (mitochondria, for you biology buffs). This is like putting a bigger gas tank on your car. You also need calcium to fire muscles, which is a great reason to support healthy bones & muscles with a supplement.
The most significant part: Strength gains in the first 5 weeks of exercise is nerve based. Let me say that another way: if you change your exercise program, and start to notice strength gains, the physical physiology of your muscles has changed very little--it takes longer for your body to grow and repair those muscles--what is happening is your brain and nerves are learning how to better coordinate recruitment and firing of muscles. We could talk all day about this. This is where the fun of treatment really begins. When I treat the brain and nerves, I can often change the strength and function of muscles immediately!
Muscle growth, power plant improvement, neurologic development...we haven't even gotten to how we use biomechanical joint advantage (leverage) to add strength. How do your muscles get stronger? One part physiology (muscle fiber & mitochondria increase), 1 part neurology (brain and nerve control), and 1 part biomechanics (leverage & joint proprioception).
Now, If you're looking to strengthen your muscle, you have so many options!
Highlights:
- different ways your muscles get stronger
- evidence for how exercise, nutrition, and activity change your muscles
- learn what you can do today to increase strength, burn more calories and feel stronger
A friend, Samantha, recently asked me what the difference is between a weak and strong person's muscles. I think it's a neat question. Especially because of how dynamic the answer may be. An initial guess is that you add more muscle tissue--and this is correct, but there's so much more! When we discover the ways muscles strengthen, we can learn how to maximize our power and health.
Muscle action explained in 30 seconds...go!
Muscles on a functional level are made of overlapping protein fibers (eg actin & myosin). When a nerve signal fires, the muscle tissue is flooded with a watery bath of ions (kind of like gatorade :) which causes the protein fibers to play a game of tug-of-war. The winner is you--and your now contracted muscles. And scene!
An increase in the number of the protein filaments (myofibrillar hypertrophy) is not always shown in thickness or bulk of the individual. This is what I call "dad strength", where my father was always lean yet could battle 2 growing boys with ease. This is also encouraging to women who are looking to add strength or calorie-burning potential without adding significant bulk.
You can add strength, especially endurance without any physical change to the number or size of muscle fibers. Through good nutrition and exercise, you may increase the power plants in your cells that provide muscles with energy to work. The more often you work your muscles, the more you're telling your body to make little energy factories (mitochondria, for you biology buffs). This is like putting a bigger gas tank on your car. You also need calcium to fire muscles, which is a great reason to support healthy bones & muscles with a supplement.
The most significant part: Strength gains in the first 5 weeks of exercise is nerve based. Let me say that another way: if you change your exercise program, and start to notice strength gains, the physical physiology of your muscles has changed very little--it takes longer for your body to grow and repair those muscles--what is happening is your brain and nerves are learning how to better coordinate recruitment and firing of muscles. We could talk all day about this. This is where the fun of treatment really begins. When I treat the brain and nerves, I can often change the strength and function of muscles immediately!
Muscle growth, power plant improvement, neurologic development...we haven't even gotten to how we use biomechanical joint advantage (leverage) to add strength. How do your muscles get stronger? One part physiology (muscle fiber & mitochondria increase), 1 part neurology (brain and nerve control), and 1 part biomechanics (leverage & joint proprioception).
Now, If you're looking to strengthen your muscle, you have so many options!
- begin with regular hydration and healthy protein sources (building blocks)
- add activity based in real-life movements (functional training). eg. walking, swimming, playing with children, gardening
- exercise regularly and with intensity to challenge your body to need more strength (5 x 40 min/week)
- continue diet & exercise changes for more than 5 weeks to see physical changes
- seek knowledgeable therapists and physicians who encourage you to move for enjoyment!
Wednesday, May 19, 2010
ADHD- Is food to blame for hyperactivity?
"Hey did you hear ADHD is caused by eating pesticides?"
"No, I heard it was from BPA in canned foods...or artificial sweeteners!"
I enjoy observing the way mainstream media presents scientific data. Oversimplification, overstating, and flat out misrepresentation of the evidence is commonplace. However, I feel they mostly do the best they can. It is very difficult to grab reader's attention, sell copy, and remain objective and rational.
Example: Monday's AP article regarding evidence linking pesticides and ADHD (Attention Deficit Hyperactivity Disorder). http://www.usatoday.com/news/health/2010-05-17-pesticides-adhd_N.htm
A friend commented to this news, "of course", which is to point the wise idea "you are what you eat". ADHD is a complicated clinical diagnosis with likely complex triggers and causes. This article is encouraging news for parents who have felt helpless with their child's development. The evidence of research continues to point to the power of nuture in helping young minds focus. Healthy behavior role modeling, balance of freedom/structure, and yes, healthy diet are all contributing factors for optimal health. Organic food producers should feel especially encouraged with the research strongly suggesting a change to organic (non-pesticide) fruits and vegetables may reverse or halt this particular ADHD trigger.
What intrigues me is how readers will often take this information to an end point of assumption: "ADHD is caused by non organic food". I feel media is complicit in this dysfunction as they often use "prove" or elude to conclusion in presentation of evidence. Biologic science is a gathering of evidence. Proof in that arena is a majority agreement of interpreters. There is often confusion and dissenting viewpoints from reasonable people. We should be cautious anytime we're referencing an article to prove a recommendation for healthy living.
As far as food is concerned, the current government subsidy (im)balance is tilted sharply towards meat and grains, perhaps this will be one more straw for a public push to promoting healthy diet backed by healthier government policy--one that promotes fresh vegetables and fruits. Though when that happens, there will be so much more for the media to present incompletely.
"No, I heard it was from BPA in canned foods...or artificial sweeteners!"
I enjoy observing the way mainstream media presents scientific data. Oversimplification, overstating, and flat out misrepresentation of the evidence is commonplace. However, I feel they mostly do the best they can. It is very difficult to grab reader's attention, sell copy, and remain objective and rational.
Example: Monday's AP article regarding evidence linking pesticides and ADHD (Attention Deficit Hyperactivity Disorder). http://www.usatoday.com/news/health/2010-05-17-pesticides-adhd_N.htm
A friend commented to this news, "of course", which is to point the wise idea "you are what you eat". ADHD is a complicated clinical diagnosis with likely complex triggers and causes. This article is encouraging news for parents who have felt helpless with their child's development. The evidence of research continues to point to the power of nuture in helping young minds focus. Healthy behavior role modeling, balance of freedom/structure, and yes, healthy diet are all contributing factors for optimal health. Organic food producers should feel especially encouraged with the research strongly suggesting a change to organic (non-pesticide) fruits and vegetables may reverse or halt this particular ADHD trigger.
What intrigues me is how readers will often take this information to an end point of assumption: "ADHD is caused by non organic food". I feel media is complicit in this dysfunction as they often use "prove" or elude to conclusion in presentation of evidence. Biologic science is a gathering of evidence. Proof in that arena is a majority agreement of interpreters. There is often confusion and dissenting viewpoints from reasonable people. We should be cautious anytime we're referencing an article to prove a recommendation for healthy living.
As far as food is concerned, the current government subsidy (im)balance is tilted sharply towards meat and grains, perhaps this will be one more straw for a public push to promoting healthy diet backed by healthier government policy--one that promotes fresh vegetables and fruits. Though when that happens, there will be so much more for the media to present incompletely.
Monday, April 26, 2010
How a Monk Solves Back Pain
What can St Francis of Assisi teach us about alleviating back pain?
A highlight on Standing Desks--A new option for back pain sufferers
Standing desks are a new idea for some, and an old, old idea for others. Notice in Bellini's depiction of St. Francis of Assisi in the Desert (http://en.wikipedia.org/wiki/File:Giovanni_Bellini_St_Francis_in_Ecstasy.jpg).
Not only is St. Francis in an amazing extended position (we'll come back to that), but look in the lower right hand corner and you will find a standing desk! He is able to stand, move, write, read, and think without the tired stance of a chair. In your most energetic state, what position would you want to be in? Likely, it is standing. I've never had a patient tell me, "I was so excited, I had to sit down and slouch."
Speaking of slouching: did you notice St. Francis' excellent, extended posture. As infants, we adapt well to curling up, and we often return to this position as we age. Full extension (back, arms, hips, and shoulders) is rare, even for mature adults. Yet, our bodies were made for extension. Perhaps we could include more of this each day.
It would be valuable for us to consider a standing desk. We could read, write, email, and even blog from an energetic position--one that allows us to move and work.
Want to dig further?: http://www.nytimes.com/2010/04/22/technology/personaltech/22basics.html
A highlight on Standing Desks--A new option for back pain sufferers
Standing desks are a new idea for some, and an old, old idea for others. Notice in Bellini's depiction of St. Francis of Assisi in the Desert (http://en.wikipedia.org/wiki/File:Giovanni_Bellini_St_Francis_in_Ecstasy.jpg).
Not only is St. Francis in an amazing extended position (we'll come back to that), but look in the lower right hand corner and you will find a standing desk! He is able to stand, move, write, read, and think without the tired stance of a chair. In your most energetic state, what position would you want to be in? Likely, it is standing. I've never had a patient tell me, "I was so excited, I had to sit down and slouch."
Speaking of slouching: did you notice St. Francis' excellent, extended posture. As infants, we adapt well to curling up, and we often return to this position as we age. Full extension (back, arms, hips, and shoulders) is rare, even for mature adults. Yet, our bodies were made for extension. Perhaps we could include more of this each day.
It would be valuable for us to consider a standing desk. We could read, write, email, and even blog from an energetic position--one that allows us to move and work.
Want to dig further?: http://www.nytimes.com/2010/04/22/technology/personaltech/22basics.html
Thursday, April 8, 2010
Do I need x-rays to see a chiropractor?
FAQ: Do I need x-rays to see a chiropractor?
Answer: No. For the great majority of our patients, x-rays are not needed.
At Tri-Synergy Chiropractic, we are focused on evidence-based medicine. We will recommend tests (eg xrays, CT, MRI) only when clinically necessary.
As a physician, I am interested in diagnosing the cause of your symptoms. I'm able to do this by providing a thorough physical exam, including appropriate neurologic and orthopedic testing. We look at muscles, bones, nerves--all of your anatomy. Not just your spinal alignment. Imaging--including x-ray, CT, MRI--may be helpful for your diagnosis, but for most of our patients, it is not needed. I may recommend treatment that I can provide or refer you to another specialist.
We do not depend solely on one form of testing to diagnose or predict treatment. We may not need any x-rays at all to help you feel better. We are more likely to recommend specific exercises for your back pain, rehab for an ankle sprain, or gentle muscle release for your neck pain.
If you are near the High Point - Greensboro, NC area and looking for a chiropractor who will solve your problem, without a lot of visits, find us: Tri-Synergy Chiropractic
Answer: No. For the great majority of our patients, x-rays are not needed.
At Tri-Synergy Chiropractic, we are focused on evidence-based medicine. We will recommend tests (eg xrays, CT, MRI) only when clinically necessary.
As a physician, I am interested in diagnosing the cause of your symptoms. I'm able to do this by providing a thorough physical exam, including appropriate neurologic and orthopedic testing. We look at muscles, bones, nerves--all of your anatomy. Not just your spinal alignment. Imaging--including x-ray, CT, MRI--may be helpful for your diagnosis, but for most of our patients, it is not needed. I may recommend treatment that I can provide or refer you to another specialist.
We do not depend solely on one form of testing to diagnose or predict treatment. We may not need any x-rays at all to help you feel better. We are more likely to recommend specific exercises for your back pain, rehab for an ankle sprain, or gentle muscle release for your neck pain.
If you are near the High Point - Greensboro, NC area and looking for a chiropractor who will solve your problem, without a lot of visits, find us: Tri-Synergy Chiropractic
Sunday, April 4, 2010
If you have the keys, you're more likely to drive it
Pitfalls of over use of testing in medicine
Continuing the discussion from the previous post:
Imaging and other tests can be a great help in diagnosis and measuring improvement. Testing also increases cost for a patient, risk of side-effects, and even harm patient outcome. It is surprising to learn the evidence behind multiple negative tests: even if a patient's tests show no direct problem, the more tests a patient has, the worse their health outcome. This means we (as patients and doctors) should be judicious in our use of all testing, regardless of whether the insurance company will cover the cost.
As a recent commentary on the NPR show "Marketplace" points out, doctors who own a testing device are more likely to use them--regardless of clinical need or benefit to the patient.
http://marketplace.publicradio.org/display/web/2010/03/30/am-cat-scans/
Patients should encourage informed consent from their doctors--information about the risks and benefits from any test or treatment recommended. Doctors who own an x-ray machine, CT scan, or access to an MRI machine are more likely to use it. Whether the increase is from a conscious drive to cover or justify machine expenses, or subconscious convenience of access--patients need to be encouraged to make informed decisions about their health care.
If you're looking for a chiropractic physician who will encourage you with informed options, check out:
www.TriSynergyChiro.com
Continuing the discussion from the previous post:
Imaging and other tests can be a great help in diagnosis and measuring improvement. Testing also increases cost for a patient, risk of side-effects, and even harm patient outcome. It is surprising to learn the evidence behind multiple negative tests: even if a patient's tests show no direct problem, the more tests a patient has, the worse their health outcome. This means we (as patients and doctors) should be judicious in our use of all testing, regardless of whether the insurance company will cover the cost.
As a recent commentary on the NPR show "Marketplace" points out, doctors who own a testing device are more likely to use them--regardless of clinical need or benefit to the patient.
http://marketplace.publicradio.org/display/web/2010/03/30/am-cat-scans/
Patients should encourage informed consent from their doctors--information about the risks and benefits from any test or treatment recommended. Doctors who own an x-ray machine, CT scan, or access to an MRI machine are more likely to use it. Whether the increase is from a conscious drive to cover or justify machine expenses, or subconscious convenience of access--patients need to be encouraged to make informed decisions about their health care.
If you're looking for a chiropractic physician who will encourage you with informed options, check out:
www.TriSynergyChiro.com
Wednesday, March 24, 2010
Make it a double--if you're trying to fit into that black dress
Intriguing article regarding a recent report in the Archives of Internal Medicine about moderate consumption of alcohol in women and weight gain. The study demonstrated a pattern of weight loss with alcohol consumption.
"Amount of alcohol consumed at baseline was inversely related to weight gain". Women who drank more--lost more weight!
http://www.medscape.com/viewarticle/718086?sssdmh=dm1.599113&src=nldne&uac=135056DN
Not only does this connect with physiologic support but multiple other studies. Individuals should always consider psychosocial effects of alcohol consumption, and the study identified subjects within a healthy beginning weight range, and without many of the common complicating factors (eg diabetes). I believe this information should serve as further encouragement that a great glass of wine, beer or a martini is To Your Health!
"Amount of alcohol consumed at baseline was inversely related to weight gain". Women who drank more--lost more weight!
http://www.medscape.com/viewarticle/718086?sssdmh=dm1.599113&src=nldne&uac=135056DN
Not only does this connect with physiologic support but multiple other studies. Individuals should always consider psychosocial effects of alcohol consumption, and the study identified subjects within a healthy beginning weight range, and without many of the common complicating factors (eg diabetes). I believe this information should serve as further encouragement that a great glass of wine, beer or a martini is To Your Health!
Sunday, March 21, 2010
Carpal Tunnel - One patient's story
Great question from a patient this week: "if it's my wrist and fingers that hurt, how come my elbow is the problem?"
The median nerve is commonly responsible for these symptoms--but surprisingly, the carpal tunnel is not usually the problem! The median nerve begins in the upper arm near the biceps and has multiple locations it can be irritated, inflamed, and entrapped. The most common location is as it crosses the elbow and weaves dives between multiple muscles that control the forearm and wrist.
Individuals who sit at a desk for multiple hours in a day or work with repeating motions in their hands and arms are particularly at risk for carpal tunnel symptoms. Athletes in tennis, golf, and throwing sports also experience irritation in the carpal tunnel.
For the patient this week, she types for 6 hours/day for work and likes to bowl twice/week. When examined, her symptoms all appeared when testing muscles that control her elbow. After 3 treatments, she no longer has the numbness, tingling, and swelling she had experienced in her hand/wrist.
At home, you can help prevent carpal tunnel irritation--especially if you have a job that requires repetitive motion or long-term holding of your hands at a computer:
I was encouraging this patient that her carpal tunnel symptoms can be caused by more than just tightness at the wrist. The carpal tunnel is located near the wrist:
Individuals who sit at a desk for multiple hours in a day or work with repeating motions in their hands and arms are particularly at risk for carpal tunnel symptoms. Athletes in tennis, golf, and throwing sports also experience irritation in the carpal tunnel.
For the patient this week, she types for 6 hours/day for work and likes to bowl twice/week. When examined, her symptoms all appeared when testing muscles that control her elbow. After 3 treatments, she no longer has the numbness, tingling, and swelling she had experienced in her hand/wrist.
At home, you can help prevent carpal tunnel irritation--especially if you have a job that requires repetitive motion or long-term holding of your hands at a computer:
- take regular breaks--Stand up 3 times/hr, roll your shoulders back and let your arms fall back
- do 3 snow angel movements, keeping your hands open and rolling your thumbs backward
- extend your wrists, elbows, and arms while taking 3 slow deep breaths
- gently move and lightly stretch your palms, wrists, and forearms
Wednesday, March 10, 2010
The more tests I get, the healthier I am. Right?
Interesting commentary about the use/value of medical testing. I really enjoyed the wisdom shared about when and how tests should be used.
http://www.npr.org/templates/story/story.php?storyId=124279916
Joe Wright, M.D. is the author of the commentary; here is his blog-- http://hemodynamics.blogspot.com/
It's important for patients and physicians to think critically and constructively for each test taken. This applies most directly for chiropractic care regarding X-rays. Many chiropractors x-ray a majority and even every patient. This is not supported by research. I feel strongly that x-rays are a valuable tool to be used only when clinically prudent. At Tri-Synergy Chiropractic, we do not suggest an x-ray unless we feel it is in the best interest of the patient's outcomes.
http://www.npr.org/templates/story/story.php?storyId=124279916
Joe Wright, M.D. is the author of the commentary; here is his blog-- http://hemodynamics.blogspot.com/
It's important for patients and physicians to think critically and constructively for each test taken. This applies most directly for chiropractic care regarding X-rays. Many chiropractors x-ray a majority and even every patient. This is not supported by research. I feel strongly that x-rays are a valuable tool to be used only when clinically prudent. At Tri-Synergy Chiropractic, we do not suggest an x-ray unless we feel it is in the best interest of the patient's outcomes.
Wednesday, March 3, 2010
The tarp goes down before the tent! --preparing a strong core
A patient came to the office this week with pain in her right hip. After reviewing her experience--pain during running, pain walking up stairs, and soreness in her thigh--and a full examination, I recommended to her we begin some core rehab beginning with Transverse Abdominis (TA) recruitment.
We will refrain from a long academic tangent about the TA muscle. She felt my analogy was more helpful: one way of thinking of the TA is like the tarp on a camping trip. Just like the tarp, proper core control begins with the TA muscle. Optimally, our TA is like a firm belt--supporting the spine, pelvis, torso, and other abdominal muscles. Our TA is located about the same place a large belt buckle would be, firming and strengthening nearly every motion of the body.
When camping, you start with the tarp, and it will help prevent moisture from ruining a good night's sleep and protect your tent. A tarp is often an afterthought yet regretted when forgotten. Just like the TA--an afterthought until it's a problem.
As you are considering "core workouts" and resolution of back, hip, or knee pain. It is a great idea to investigate whether you are able to engage and utilize the Transverse Abdominis. It may be the answer to your symptoms.
At home test: touch the bony prominences in the front of your pelvis (6" to the side of a belly button and 3" down). Now move to the center 1" and down 1". While lying on your back, and holding 2 fingers at that spot, gently firm the muscle under your fingers. Did you feel it? Many of my patients have a tough time finding this, so do not dispair! It is important to be able to hold that muscle firmly while still able to breathe deeply, letting your belly rise and fall. Many patients bring their "six-pack" muscles into it, and this is not optimal. Continue to contract and relax these muscles in a gentle rhythm. You are now working the TA and helping your brain become more aware of this muscle! If you have difficulty performing this contraction, or draw other muscles into it, it may be a sign of TA dysfunction leading to other symptoms. Consider it as you seek to reach your pain-free goals!
We will refrain from a long academic tangent about the TA muscle. She felt my analogy was more helpful: one way of thinking of the TA is like the tarp on a camping trip. Just like the tarp, proper core control begins with the TA muscle. Optimally, our TA is like a firm belt--supporting the spine, pelvis, torso, and other abdominal muscles. Our TA is located about the same place a large belt buckle would be, firming and strengthening nearly every motion of the body.
When camping, you start with the tarp, and it will help prevent moisture from ruining a good night's sleep and protect your tent. A tarp is often an afterthought yet regretted when forgotten. Just like the TA--an afterthought until it's a problem.
As you are considering "core workouts" and resolution of back, hip, or knee pain. It is a great idea to investigate whether you are able to engage and utilize the Transverse Abdominis. It may be the answer to your symptoms.
At home test: touch the bony prominences in the front of your pelvis (6" to the side of a belly button and 3" down). Now move to the center 1" and down 1". While lying on your back, and holding 2 fingers at that spot, gently firm the muscle under your fingers. Did you feel it? Many of my patients have a tough time finding this, so do not dispair! It is important to be able to hold that muscle firmly while still able to breathe deeply, letting your belly rise and fall. Many patients bring their "six-pack" muscles into it, and this is not optimal. Continue to contract and relax these muscles in a gentle rhythm. You are now working the TA and helping your brain become more aware of this muscle! If you have difficulty performing this contraction, or draw other muscles into it, it may be a sign of TA dysfunction leading to other symptoms. Consider it as you seek to reach your pain-free goals!
Wednesday, February 17, 2010
Should we be concerned about plastic water bottles?
BPA- the controversy.
There continues to be an interesting discussion regarding Bisphenol-A (BPA). Should we be concerned regarding plastic wrap, tupperware, and water bottles?
BPA is a chemical contained in some plastics--many of the food-grade plastics we use daily. I've found this discussion on NPR's science Friday to be extremely helpful in continuing the discussion. It's important to remember how challenging known toxic substances are to evaluate--unknown (like BPA) are likely to be a point of challenge for years to come.
http://www.sciencefriday.com/program/archives/201001223
My advice:
There continues to be an interesting discussion regarding Bisphenol-A (BPA). Should we be concerned regarding plastic wrap, tupperware, and water bottles?
BPA is a chemical contained in some plastics--many of the food-grade plastics we use daily. I've found this discussion on NPR's science Friday to be extremely helpful in continuing the discussion. It's important to remember how challenging known toxic substances are to evaluate--unknown (like BPA) are likely to be a point of challenge for years to come.
http://www.sciencefriday.com/program/archives/201001223
My advice:
- limit contact by using glass or metal bottles. Stainless steel bottles are available everywhere
- avoid reheating food in plastic. It tastes better on a plate
- use glass or BPA-free baby bottles for infant feeding
Wednesday, February 10, 2010
Should I use ice or heat?
Benefits of hot vs cold for an injury.
Perhaps you've had a twisted ankle, sore elbows from another day at that desk, or stubbed your toe in the middle of the night. A bucket of ice is painful and it's just too difficult to sleep under a hot shower. What should you use to help calm symptoms of pain and swelling while increasing healing time? Let's look at the physiology of your body:
Disadvantages:
All injuries should be evaluated by a medical professional. Feel confident that ice or heat may be a great part of helping you heal and feel better.
Perhaps you've had a twisted ankle, sore elbows from another day at that desk, or stubbed your toe in the middle of the night. A bucket of ice is painful and it's just too difficult to sleep under a hot shower. What should you use to help calm symptoms of pain and swelling while increasing healing time? Let's look at the physiology of your body:
Ice
Advantages:- numbs skin sensations by slowing nerve conduction
- overwhelms nocioceptive input from region (part of a pain signal) which limits sensation of pain
- limits inflammation and swelling by constricting blood vessels thus reducing blood flow
Disadvantages:
- limits inflammation--wait, what?--yes, inflammation is part of a healthy immune response to injury. The body will heal best with optimal amount/timing of inflammation, not a removal of it.
- slows delivery of oxygen and nutrients by reducing superficial blood flow
Heat
Advantages:- promotes blood flow which increases delivery of oxygen and nutrients
- blood flow to superficial nerves often relaxes and calms pain symptom
- may increase inflammation in acute injury
- may aggrivate and increase sensations of pain
- In general, injuries respond best to ice in the first 72 hours as the initial stages of inflammation are still taking place. After 3 days, do what feels best to you. Each persons body may respond differently to heat or ice.
- Restrict either to 20 minute intervals with at least 20 minutes of rest between. You body needs time to restore normal temperature to superficial tissues. Avoid ice or heat if it adds great symptom increase.
- Both ice and heat affect maybe 2 cm deep. They are used to help you feel better, not as a cure all. Hands and feet are the most affected tissues by ice/heat because they are thin enough to change temperature. The causes of low back pain are rarely altered by temperature change, though your symptoms may be helped.
All injuries should be evaluated by a medical professional. Feel confident that ice or heat may be a great part of helping you heal and feel better.
Tuesday, February 9, 2010
How do I choose a chiropractor?
Finding a Chiropractor
This question was most recently posed to me while lecturing at Wake Forest School of Medicine. M.D.'s are asking; patients are as well. The following are guidelines that I feel are most important to consider.
Interview all physicians, especially your potential chiropractor. There are a wide variety of techniques and attitudes of D.C.'s (Doctors of Chiropractic) as how they approach patient care. Look for one who is:
Problem signs:
I encourage my patients to have a goal when they visit (e.g. less neck pain, more shoulder motion, less tingling in their fingers). Patients are seeking progress and chiropractors should also. Some chiropractors are willing to treat a patient weekly to maintain health--this has limited and sinking support of scientific evidence. Find a chiropractor who is helping you reach your goals, not someone who is helping pay for their new boat.
This question was most recently posed to me while lecturing at Wake Forest School of Medicine. M.D.'s are asking; patients are as well. The following are guidelines that I feel are most important to consider.
Interview all physicians, especially your potential chiropractor. There are a wide variety of techniques and attitudes of D.C.'s (Doctors of Chiropractic) as how they approach patient care. Look for one who is:
- Cooperative and competent
- advises treatment based on a diagnosis
- releases patients after improvement
- engages you as a physician, not a technician. This means someone who looks at your experience as a human, not just a machine to work on.
- treats with more than just manipulations or adjustments. Look for a chiropractor who also offers nutritional, soft-tissue, and exercise expertise.
Problem signs:
- focused on "subluxations" or alignment only
- talks about bones out of place
- requires x-rays in order to treat you
- encourages patients to sign a contract or suggests frequent maintenance care
I encourage my patients to have a goal when they visit (e.g. less neck pain, more shoulder motion, less tingling in their fingers). Patients are seeking progress and chiropractors should also. Some chiropractors are willing to treat a patient weekly to maintain health--this has limited and sinking support of scientific evidence. Find a chiropractor who is helping you reach your goals, not someone who is helping pay for their new boat.
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