Sunday, August 26, 2012

Why 3 times a week?

Why 3 times a week?  This is a question I often get. This question often turns into a patient "skipping appointments" once they are out of pain. So,...why?

Actually it's a very good question. Why come when you're feeling "GOOD"? No need right?
WRONG...and here's why.

For the patient that comes regularly, they will remember the first 2-4 weeks, the adjustment sometimes holds for 1-2 days. In fact, I have had patients where the the first week, the adjustment was lasting "hours",.....not even a day. So, what increases TIME for the adjustment.

1) TIME....simply that. Healing is by momentum, and healing takes time.
2) Patient's ability to RELAX during an adjustment. It sometimes takes a few weeks for the patient to become "trusting" to the doctors hands. The more the doctor can move the bone without patients  creating a muscle restriction, the longer the adjustment will hold, and the faster the healing process will begin.
3) Muscles, ligaments, soft tissue ;.... Often there is some type of damage or repair that has to occur in order to progress further in that patients health. Here is an example.
e.g. Patients often come to me with tight Iliopsoas muscles and when I look on x-ray I will often see a shadow of the Psoas Major and Minor attachment to the vertebral bodies. So, when the muscles are extremely tight, they will pull on their attachment sight as well as their origin sight.
e.g.#2 I had a patient with that very issue that went and played tennis........"Oh,".  In tennis, the amount of transverse leaning of the body with extension of the legs happens as a person stretches out to try and get a ball out of their reach. an overactive muscle (tight muscles) will cause pain,...and in this person's case, it caused a temporary postural distortion....we had this patient come into clinic for 6 times in 3 days as the patient iced for an acute injury and did postural training. By the end of the week, the patient had returned to their original posture.
4) Postural distortion: Many patients have this issue. Pre-posture training (primary curve lordosis laxity training...or in clinic we call it the "towel exercise"), posture training (mirror image and proprioceptive repetition) will enhance posture. If a persons posture is not well, the possibility of an adjustment holding for an extended period of time,... is "Slim to NONE".
5) Injury (trauma). This is often in conjunction with point #3. However, this can also include bones that have been seriously realigned. Sometimes in a permanent fashion. Therefore the chiropractor has his/her hands tied because the limitations of success decrease due to injury and the amount of damage done to the body.
6) Ergonomics: Huge problem. We get patients who sit in front of a computer 8-12 hours a day. How successful is the patient going to be if they keep putting their body in this mechanical malposition for hours upon hours, and then don't do anything to correct it. In addition to WORK stress, the ergonomics are often poor. (bad position of keyboard, keyboard promotes Carpal Tunnel Syndrome, hand on the mouse for hours, the height the arm is positioned in most of the day may create tingling/numbness in the arms/hands/fingers, type of chair may promote Low Back Pain, the height of the chair may promote slouching, may promote other mechanical stress issues).
7) Patient is NON-compliant. This is generally the case. Even if a patient comes 3x a week, but doesn't do things to improve their ergonomic stress, doesn't do their at home exercises and stretches to decrease recurrences, etc..., this patient then is on a treadmill and the progress is slowed down.
Patients deciding on their own to decrease their care time because "they don't feel pain anymore", will start to put themselves on this rollercoaster of pain vs. no pain.

The amount of time a patient is in clinic is dependent upon their ability to heal and HOW FAST they're healing. Each patient is different, and each injury is different. Let your body do it's magic. Your body is a healing mechanism and the chiropractor is acting like the mechanic of your body. If you feel tightness and stiffness after exercising your body,...the chiropractor will note that,...but often expect that from patients who are going through a body structural transference. THIS IS NORMAL. That brief period of feeling "tight" or "stiff" or even "pain". Ever go to the gym and lift weights? How did it feel the first time you lifted weights? Feel sore the next few days? Of course you did. You're going from non-use to use and your body needing those few days to heal again. It's perfectly normal for your body to feel that way right? Of course it is,...therefore it's as normal to feel stiff, soreness, tightness, and even recurrences of pain when you exercise and go to chiropractic clinic. But,'s the good news. The ability for the body to heal faster also happens. These patients usually are my successful patients, for they are willing to put in that little bit of sacrifice and they get amazing results.

I tell my patients this. " THE MORE YOU PUT INTO THE WELLNESS OF YOUR BODY,... THE BETTER RESULTS YOU WILL GET IN THE OUTCOME".  Meaning, if the doctor says "10 minutes a day of exercise is the minimum you should be doing..." and you perform 1 hour a day,....these patients will end up  with better results than the person who does the bare minimum.

Let's start putting the emphasis where it belongs...YOU control your own health's ability to heal. So,...leave the excuses at home, and come in to clinic with that wonderful "get well" attitude, and you'll marvel at how well you can do.

To good health,....
Dr. G

Monday, July 2, 2012

We'll Try, I Hope So and Maybe...

We'll try to come tomorrow. I hope I can make it. Maybe this weekend I'll come. The one thing that ALL 3 of these statements have in common is "Non committal". These patients tend to be some of the worst patients.

In fact, these patients often look to blame EVERYONE ELSE for their non-successful ways,...but themselves. Here is an example. I just recently had a patient that came in to my clinic 6 + months (closer to 7) to have me review their post-x rays. Excuses were flowing from her lips like water from a faucet.
* I broke my ankle.
* She's (her daughter) lazy
* busy
* school

I had to stop the flow of excuses before I got flooded out of my office. Then there was the "blame" period. You said she had 10 degree scoliosis and now she has 16 degree. This was inferring that I,...Dr. Giovanni was responsible for the increase in her daughter's pre-scoliotic back.
1) There wasn't an increase. (Have to be careful of that for sometimes one doctor says something and this may set off a cascade of,...absolutely no increase)
2) Patient was BEYOND non compliant, and could never expect any improvement with the minimal effort they were performing.
3)  We searched all of our paperwork and exam reports and radiographs and there was never a mention of 10 degrees. So,...guess the patient heard what THEY WANTED TO HEAR. 

Interestingly enough, these are the type of patients that will never succeed. They are full of excuses, full of blaming others for their inadequacies, and they never work hard.

When told of the MINIMAL requirements for them to succeed,........what did I get from them? MAYBE, I HOPE SO, WE'LL TRY.... let me re-translate that for you.

1) Maybe I will come maybe I won't. Probably won't for we're too lazy we love making excuses instead of making things work.

2) I hope we can come... I really have doubts or reservations, but I think I will passify you as a clinic so that I can escape here unscathed and can leave the clinic again....non-committal.

3) Maybe we'll come this weekend...well, at least I hope you will buy that line of bologna for I know that I have zero intention in coming, but I want to leave the clinic unscathed and again without commitment.

Here's the thing,...the only person they are FOOLING.....ARE THEMSELVES.

If people truly don't wish to get well, but merely use Chiropractic as a magic pill,...that is what is going to happen no matter the education and no matter how bad their condition is. Therefore,... my advice to patients (or future patients) is to look at themselves and see what kind of work they are willing to put into their health,...then try to attain that goal. I believe honesty with YOURSELF first is the best policy,...then inform your doctor of what your GOALS are and how you wish to obtain that goal.

To good health,

Dr. G

Wednesday, June 20, 2012

In Clinic Exercises

Exercise is extremely important when it comes to overall health. Sure, I love it when a patient tells me they are doing palates, yoga, swimming (on a regular basis),...but, it is also important to do daily stretches to prevent injury, as well.

The exercises you will see here are regular exercises performed IN CLINIC. I have had patients ask me to post this for a while, to give them a reminder of how the exercises should be performed.

So,...let's begin,...shall we? (THIS NOTE WILL BE HERE UNTIL ALL THE EXERCISES HAVE BEEN LOADED>...then I will delete this note).

Circle Abduction
Circle abduction: circular motion  (outside to inside)
Circle abduction: abduct/ extension
shoulder shrugs (3kg)
Circle Abd'n w/ ball
Bucket Pulls (standing Oblique)

Soccer Throw
Isolation Tricep Curls
(Iso Tricep Curls)
Standing Flys

bicep curls (w/ anything)

Thoracolumbar torque

Ipsilateral Seated Bicep Curls

Oblique Stretches
Iliopsoas Stretch

chest press w/ ball

Wabble Stick/Balance Cushion

chest press using the wall

triceps curls using barbells
Puma Crawl (scoliosis training)
Pec-Stretch with exercise band

Quadriceps Strengthening

bicep curls w/ tubing
Rhomboid stretch using door (Stretches deltoid muscle as well)
Hamstring Stretch
Hamstring & Gastrocnemius  stretch
Lawnmower Pulls
Deltoid Strengthening
QL stretch
Quadratus Lumborum Stretch (QL)

Sunday, May 20, 2012 to properly treat it.

Scoliosis... Let's first talk about the DEFINITION of scoliosis.

Scoliosis is the Lateral curvature of the spine with a convexity greater than 20 degrees. (In plain English) It is when you look at someone from behind and see a curve in their back. When measured by Cobb's Angle (manual measurement source used by M.D's and Chiropractor's alike), the angle is greater than 20 degrees.

This is about all the chiropractors and medical doctors agree upon though. Many medical doctors recommend things like swimming, or simply waiting until the curve gets to an uncontrollable  level, that surgery or bracing is the only choice.

In our clinic, we believe in trying to prevent the disease as much as possible.

Okay, we explained WHAT scoliosis is,...but HOW does one obtain scoliosis? Approximately 50% of the time it is believed to be inherited (genetic), the other times by trauma. Trauma part is the tricky part. For many times when the initial injury occurs, there is no sign of injury. (On radiographs (Ronson's), there is no sign of fracture or movement of bone). But, I want you to think of a wave.

There is a WAVE effect. This sine wave effect happens immediately, but the visual and painful effects may take years to take place.  There are clues that a doctor will look at when we try to diagnose the cause of injury.
1) The convexity of the curve is not Right thoracic or Left Lumbar.
            -   There may be only one curve, or it may be an opposite side  of normal convexity. Most of the                                    
                 convexities are Right Cervicothoracic and Left Thoracolumbar. (~80%).
2) Patient had a prior trauma during the growth period of their lives (ojek/motorbike...fall off the bike)
            -    Like I said, there may not have been any signs of injury just POST accident, but the sine wave effect is great.
Typical Right Thoracic Convex Scoliosis

There have been many studies done on how to decrease the scoliotic curve, both in the medical profession and in the chiropractic profession, as well. Restriction or confinement by

The best way is to brace. Why is that?...Well, I try to tell patients to think of a "lead pipe". Think of how you would straighten that out? By taking a hammer and hitting it everyday? No,...not really.
But, if you put it in a vice, and then torque it,...and HOLD it in that position for hours or even days,... the curve of that lead pipe will be decreased.

This is how straight your back should look.
If crooked,. what kind of tools would it take
to bring this pipe back to being straight?

But, when we are using this analogy, remember that is a PIPE we are talking about,...not a human being. Remember we are dealing with the psychology of patients. Especially young children. (girls in particular since girls are 10x more likely to get scoliosis than boys). They simply WON'T wear the brace because of ridicule, "it's too tight and makes the back feel really stiff, embarrassment, feeling inadequate, the cost, the bulkiness, or simply lack of discipline (among other reasons). Whatever the reason, the psychology of the human mind plays a big part on why people will NOT wear it.

Therefore, bracing hasn't been as successful as people have hoped it would be,...only due to people not being proactive in their own care.

So, how do we rectify or 'better' that situation... We do A LOT of in clinic work.
a) Proprioceptive exercises.
b) muscle stretching and strengthening to properly activate muscles on the concave side of scoliosis.
c) Torsion exercises to promote behavioral training of muscles and biomechanical structure.
d) advanced chiropractic adjusting. Adjusting specifically for prescoliotic or scoliotic patients.
e) promote an environment that patients feel they can succeed at.

11 yr. old girl pre-scoliotic. Exercises and adjustment

Chiropractic-First and Dr. Giovanni (Intro video)

We have been introducing a lot of torsion (torque) exercises, with muscle proprioceptive training. The results have been astounding. Now, granted these patients come in 2-3 x a week and they are extremely proactive in their care. So, don't think these results are typical. Atypical,...only because most patients generally expect the chiropractor to fix everything and they can sit back and do nothing. 

There can always be some type of improvement. We presently have a 60 year old woman with a +50 degree typical Right Convex cervicothoracic curve and a typical Left Convex thoracolumbar curve...and in 3 weeks at 3 x a week, ... she has shown massive improvements. By seeing these improvements, this has given her further motivation to go further. So, her confidence is almost as high as her NEW quality of life. 

Remember to have your daughters (especially daughters) checked for scoliosis by age 10. Especially if you have a family history of scoliosis. Girls get scoliosis 8-10 x more than boys.  So, check them out early and save themselves years of distresses pain. Thank you again.

Dr. G

Monday, April 30, 2012

Medical Doctors Improper Diagnoses

The improper diagnoses that occurs here in Indonesia by the medical doctors is "astounding". So, if you feel you have been improperly diagnosed,......don't just take one opinion......go for quite a few. Don't take a look at someone's position in the hospital as: (higher position in the hospital must mean they know more).
For many of the "old grey hairs" lack even MORE knowledge than the younger generation.
The medical doctors are "OFTEN" not qualified enough in Indonesia to the point it often scares many people to fly to Singapore, Australia or Malaysia for further opinions. I completely concur. If I needed to go to a medical doctor for any type of surgery, I would NOT get it done here in Jakarta. I would be on the first plane to Sydney.

Let me give you an example of the comments some of these "esteemed" medical doctors who are supposed to be the best in their field have made to patients.

A) One man,.....who was touted as the "best" scoliosis doctor in Indonesia, simply told her patient to "buy NEW shoes" to help her reduce her pain of scoliosis. She was told she would live with her pain the rest of her life.

B) Recently, I was told by a 50+ yr old lady that she needed HEART surgery because she had shoulder and intrascapular pain. The doctor said this often occurs because the patient has heart issues. I told the patient to go to that doctor and "punch him in the nose". The patient has a moderate case of cervical radiculopathy.........that's it....She'll be fine in a few months of chiropractic care along with postural exercises and muscle stretching and strengthening exercises.

C) A reversed lumbar curve: The orthopedists all said to this 51 year old man that he needed surgery to help him with his pain.  Outcome? He came for chiropractic care and within 3 months the curve in his back returned and he hasn't had a day of pain for the past 2 months.

D) Another patient was flown to Singapore where they performed a S$48,000 surgery where they cut open his back at L4-L5 put a "CLAMP" on his back (yes,...they charged him this absurd money for this idiotic surgery).......where the surgery was essentially NOT ONLY ineffective, but created partial paralysis of the leg and the pain actually increased......Oh MY GOD!
Outcome?....he came to chiropractic care and within ONE WEEK the pain went away. The pain has yet to return and he played GOLF after the first week. He's been in care with me for almost 2 months now, and instead of a grimace or a sad face,....he now walks in with the biggest smile on his face.

These are terrible cases of improperly diagnosed patients....and it continues on an everyday basis. I sometimes want to slap my head with sure amazement of the moronic decisions by the Indonesian medical  staff.......Please doctors,...I IMPLORE YOU,.....quit trying to make a "quick buck (Rp)" ...and start properly treating the patients.

The Medical paradigm here in Indonesia is set so they usually follow this course that I have written below. I made an example of a typical patient that goes to the doctor...and here is usually what is said to that patient.

E.g. #1 : 55 year old male/ business professional / travels 2-3 a month by plane out of country /
weight and height: proportionate / history of high blood pressure last 15 yrs. / exercises when is not in pain (about 4 hours a week) / in addition to LBPn patient has: altered posture, tightness of upper back muscles, headaches that occur in top of head or behind the head.

Patient :  Chief Complaint: Pain in between the shoulders?           ------------> M.D.   EXAM                    
                                         * pain in neck, stiffness                                            Family Hx> No issues  
                                         * pain is constant                                                      Previous Trauma> none
                                         * "pain goes across my shoulders"                           Onset of Injury> 5+ yrs
                                         * Worsens throughout the day                                 Cz of Injury> unknown
                                        * pt says they have some knee pain also                 > Blood Pressure: 150/100
                                                                                                                        > Small Muscle Test: WNL
                                                                                                                        > Pain killers prescribed
Medical Doctors Diagnosis for this?:  High Cholesterol  or Gout

I cannot tell you HOW MANY times I have heard these "improperly diagnosed" diagnoses.

Proper Diagnosis? : Not enough information to make a diagnosis. More information is needed. Orthopedic tests: Need to differentiate diagnosis.
Is this a Cervical Radiculopathy?..... Often the case.                                
Postural distortion: is this directly related to the problem? Most likely.......
AC joint issues? Would add to postural distortion to ease the pain at directed area
Is there any numbness or tingling down the fingers: Often w/ Radiculopathies
Radiograph's: Convexity of spine?    Vertebral subluxations?  Anterior head                          
                       translation? High Shoulder?  Often help with Diagnosis.
What do they do for a living? - Does their work environment add to their issues?
                       (ergonomics, work related stress, postural distortion during work).
Knee pain :  in this case is unrelated to gout. 1st of all the doctor cannot make that diagnosis without doing a blood test and seeing what the URIC ACID level is. If that level is above 7.0,....then other factors must also be considered. (what does the diet consist of?) Did it start as Podagra (the big toe), did the symptoms occur in the middle of the night? (gout usually occurs at night because it goes to the joint area that is the coolest....(big toe)....then gout works it's way up to the knee joints, hands..., any indications of tophi ? Unilateral or bilateral?  Any signs of inflammation at the joint?, pain is usually so debilitating with gout a patient cannot often walk. Recurrences? How long are the attacks?, the doctor just throws out this word......."gout".......and sends you home.
The patient will then be sent home. Cost: ~ 600,000 Rp including cost of the Rx: (prescribed drugs).

Patient returns to Medical doctor :    CC: same.....             -----------------> M.D.  X-RAYS (RONSON)
Medical doctors look at X-rays much differently than the US/Canadian/Australian trained chiropractors.
The Medical doctors in Indonesia often don't even know how to read the radiographs. They simply read a report. Here are the four (4) things the medical doctor is trained to look for on the x-ray.
1) DJD/DDD  (degenerative joint disease/ degenerative disc disease)
2) CA (Cancer)
3) Anomaly of bone
4) Fx (Fracture)

Medical Doctors look at these 4 things only. They will "assume" since he's a 55 year old male that he's got degeneration.....Yeah, usually the case. SO,.......the "you're just getting older" card comes out. The patient will have some types of degeneration at that age. Often the radiologist won't detect cancer, anomaly of bone or a, the result?.........Rx (more prescribed drugs) and send the patient to PHYSIOTHERAPY.....

Physiotherapy. The patient tends to feel a "little relief" during this time, but will often seek other things to help them with their pain. (belts, shoulder girdles, ointment, patches, massage, TCM (Traditional Chinese Medicine), Shiatsu, swimming, yoga, acupuncture,  heat lamps, ice packs, wraps).....all to try to get rid of the pain as quickly as possible. First of all,......many of the patients who get to this stage generally are living a life without exercise...or exercise is minimal at best. So, they become IMPATIENT. They expect the "magic pill", they go to a few sessions of physic.....don't get the results they want and quit....
Others, will go for 15-30 sessions, ...and realize that physio isn't working for them either.

Patient returns to the Medical doctor:  CC: Same........> M.D.  MRI
                                                                                                 Looking for HNP

General practitioner  will send their patient to either an orthopedist or a neurologist.

Neither one knows what the issue is and will come up with some wrong diagnosis and often LIMIT the person's movement in order to reduce the pain. Some, will recommend surgery (without having a clue what the actual problem is).....they will say.....Nerve impingement.

Nerve impingement can be reduced or eliminated through proper chiropractic care and exercise.

Now,...a HNP is very rare (extremely rare) at the upper vertebrae unless a major trauma (accident) happened. So, what is usually diagnosed is many hours of physio, swimming, reduced muscular activity (restriction), change the mattress,  where a restrictive belt, change positions of sleeping.....and whatever "bullcrap" they can think of that makes absolutely no sense. But, the patients usually buys the doctors misdiagnosis and will go YEARS with living in pain. It wasn't until just recently I just heard that a doctor recommended heart surgery without doing the following:
1) ECG:......was normal.
2) Neurologic testing and send to Neurologist for further evaluation.
3) properly look at the signs and symptoms.......Patient was often out of breath due to the fact her back hurts. I want to SCREAM at the idiocy........Listen doctor....... let's look at the facts.

a) patient has tingling/numbness in fingers.
b) pain in between the shoulder blades
c) NO pain on left medial arm.
d) patient ISN'T out of breath during regular inspiration without activity.
e) Patient doesn't complain of chest pain.
g) blood test : all within normal limits
h) Patient has : Anterior head translation, rounded shoulders, pain upon palpation in pectorals, tightness/stiffness in upper back...but not too painful/...more sore.
i) Patient isn't leaning to one side or another ..or leaning forward to protect their heart.
j) her diet doesn't consist of high cholesterol food.
k) she doesn't have a stressful job

Does any of this sound like a patient who needs Heart surgery?
The patient was properly diagnosed with cervical radiculopathy. Three- four months of regular chiropractic care and exercises (ligament laxity, postural changes, muscle stretching, muscle strengthening),...the patient will be JUST FINE.......JUST FINE!!!!

People? Does this sound like you? Do you know someone like this? It happens every SINGLE day. I get patients in telling me the same bologna all the time.

It's time to put a stop to this and let people know that chiropractic care is the proper solution to many of these improperly diagnosed cases. However, since the medical community doesn't make any "money" off of chiropractic,....they'll never recommend chiropractic to their patients. Become educated people!!!! Learn to get your life back the proper way.

To good long, live strong...   -Dr. G

Thursday, April 19, 2012

Pregnancy and Chiropractic

I was able to SEE the wonders of chiropractic on a pregnant expectant mother, someone close to me was pregnant and I adjusted her all throughout her pregnancy....up until 7 hours prior to delivery.

Zachary Lucismael....the little man that was in the belly of the mom I adjusted regularly during pregnancy!

One of the biggest questions I will get is: Is chiropractic SAFE for a woman and child during pregnancy? ABSOLUTELY YES!

There are 3 trimesters during pregnancy.
First Trimester (Months 1-3)
Second Trimester (Months 4-6)
Third Trimester( Months 7-9)

During each trimester, the mothers body changes to prepare for baby. During the pregnancy the mother's musculature changes. It is important to have the body as ready as possible for a smooth delivery.
* Making certain the pelvis rotated so the pelvic inlet is as accessible for the baby to be born.
* Making the pregnancy as painless for the mother. Ligament laxity occurs in the mother which will allow a larger lumbar lordosis, but this often puts undue stress on the mothers back, often making the mother less mobile and sometimes even bed ridden.

It is important that the mother prepares her body, as best as she can prior to pregnancy. However, if the woman is already pregnant, then taking proper precautions to minimize the pain, increase chances of successful delivery should be her priority.

The mother will often experience a lot of "tenderness", and fatigue, as the body is working overtime to prepare for the fetus. The ligaments in the body start to become more "lax"... therefore if the posture wasn't good to begin with,......this problem will lead a mother right into the path of : low back pain.

People are NOT usually going to change.........This is a problem we must deal with as chiropractors every single day. A person that doesn't do exercises prior to pregnancy, isn't going to wake up one morning and all of a sudden jump right into 30 minutes of exercise...........So, this step has to be slowly done.
1) Doctor must stress importance of exercise
2) Patient must recognize the importance of exercise and the ramifications of a lack of exercise
3) Doctor must educate the importance of chiropractic care.
4) Patient must recognize the importance of that chiropractic care for her body and the importance for the expectant baby. Patient must recognize that chiropractic care is completely safe and harmless to the fetus and mother.
5) Step by step direction into exercises. Walk the mother through it.
6) Postural correction is vital for success during pregnancy. The ligaments are loose and the musculature will act in accordance to what the body is told to do.

Mothers often experience morning sickness, nausea, leg cramping, pain tingling and numbness in the fingers (a cervical radiculopathy), constipation, body aching all the time, sense of smell increases, incontinence, hemorrhoids, body swelling, general back pain, mood swings, general back pain, and body weight changes significantly.

Kegel Exercises are important during this time. It starts to build up the perineal floor....the muscles that support the bladder, uterus and her bowels.

Chiropractic care in conjunction of seeing the gynecologist, and Kegel coach or Yoga/Palates instructor for perineal floor strengthening exercises. (Swimming is highly recommended during the 2nd trimester of pregnancy. )

TO do Kegel exercises one must remember that this a a "contractile muscular exercise"........NOT difficult to do at all.

FIRST, the mother contracts her muscles as if she is trying to stop urine flow or from passing gas. Contract,...let go,....contract,....let go. Mother can perform these exercises while sitting or lying down. The muscles she will NOT want to contract will be the stomach or the buttocks. Once she can do that,...then she is properly strengthening the perineal floor. 2nd trimester : 5 times a day for about 3 minutes each. 

More weight gain, low back pain, bed ridden mothers, cervical effacement and dilation, abdominal achiness, sometimes (as in my friend) morning sickness can continue, neck stiffness, leg pain, brest tenderness, and fatigue.

Chiropractic care at this time is critical. This is the time the doctor makes certain the pelvis is properly rotated for delivery. (This will take a great deal of patient participation by meeting regularly scheduled visits and performing all stretching and strengthening exercises. The doctor will not be able to rotate that pelvis all by him/herself).

In my clinic, I will give in clinic and at home strengthening exercises to perform. The patient will be able to get those exercises from me. The strength and time of the exercises will be determinant on these factors:
1) How pro-active is the patient?
2) What did her back look prior to pregnancy?
3) Signs/symptoms patient is experiencing during the pregnancy.
4) Ability to complete the assigned exercises without issue.

If you are pregnant, or have thought about getting pregnant, need to worry yourself during your pregnancy. Understand that "preparation" is the best medicine...not drugs.

Good Health.

Dr. G

Monday, April 9, 2012

Hurrying Up Care-Plans Isn't the Answer

Many times I will have patients who love to hurry up patient plans. This could be for various reasons. (time, don't see the value anymore, lost interest, financial). Whatever the reason may be, the only person they are doing a disfavor to is THEMSELVES. I will often say this to my patients. HEALING IS BY MOMENTUM.
Your body is like a well oiled machine. But when it breaks down, it's not because it JUST broke down, but it was decayed down , or dwindled down. Meaning, it often took an extended period of time before the body ended up in that state. The pain they feel is a result of that body breaking down over an extended period of time. 

Here's where the problem often lies. The patient no longer "feels pain". If they associate pain as their measure stick,...or determining factor of how well they are,......they will never progress to full wellness. The reason being? Because PAIN removal is often the first part of healing the body, that often occurs. It is often takes the shortest amount of time in the healing process.  

So, what if the healing takes a long time? What if I keep coming back for the same things?
Everybody's body heals at different rates. We often tell patients that within 48-72 hours during the first 3 months, the body will often return to a subluxation. Why is that? Postural distortion, unbalanced muscles, repetitive stress on the job, poor ergonomic repetition, lack of exercise that the doctor instructed the patient to perform, lack of sleep, lack of destressing the body, etc...all play in the role of "return to subluxation". 

I often have a patient come by my clinic, time after time, with the same problems, and when instructing the patient  to change simple ergonomics at work, or practice postural exercises, or perform proprioceptive mirror image exercises,... but the patient FAILS to do so,... the problem will consist over and over. I give the chart of 6 things a patient must have in their live for improved health.

1) Proper Nutrition: (this is working the body on a cellular level). 
2) Proper Supplementation: What you don't get by diet, you get through supplements.
3) Regular chiropractic care: Making sure the Nervous System operates as it should.
4) Proper sleep: can't run a body ragged. You'll run the body down. Lower it's immune system. The body won't function properly.
5) Proper exercise: Again, the body will not function at it's fullest potential if it's sitting all day behind a desk.
6) De-stress the body: Lowering the cortisol stress in the body reduces weight, lowers blood pressure and allows the body to feel "fresh". 
Only ONE of these things requires an outside person to perform. That would be 'regular chiropractic care'...the rest are completely up to YOU. So, ~17% is the chiropractor, ~83% is ALL YOU.

So, as you look further into chiropractic care, you will realize that healing the body is NOT done by the's done by your own body's innate intelligence. We, as chiropractors, remove those nerve interference's and ALLOW the body the opportunity to heal itself to it's utmost potential. If you think you can go through your same problematic situation and still get the same results,...well then, you'll need to rethink about chiropractic, for chiropractic isn't a magic pill. Good luck and good health.

Dr. G 

Wednesday, March 21, 2012

Repetitive Shoulder and Neck Stiffness

This may be the biggest issue I have to deal with in clinic. It's an issue because the stiffness and/or pain constantly reoccur. A patient comes in for an adjustment, and appears to constantly have the same problem over and over again. Pain/stiffness around the shoulders or around T3-T4 (Intrascapular pain).
Does this sound like you? Pain goes away after the adjustment, and within 2 days the pain often returns. Does this sound like you? In this blog we will go over the WHAT is happening, WHY it occurs, WHY it reoccurs, and HOW to prevent it.
(many of these pictures came from Dr. Steve's blog from neck solutions.)

What is happening?
Patient comes into the clinic with pain stiffness in the back of the shoulder or in between the shoulder blades (intrascapular stiffness/pain).

Neck and scapular pain without arm or finger pain can be caused by a pinched nerve.
Intrascapular discomfort or neck pain/stiffness are very common signs of a pinched nerve.
This is usually do to a radiculopathy. Radiculopathy is damage to the spinal roots. The doctor will find out where along that spinal root fits that particular radiculopathy. This is what patients need to know.:
A radiculopathy often appears before any symptoms of pain, numbness or even weakness in the arms and fingers. The pain/tingling/numbness one feels in the fingers is usually delayed weeks (maybe months) after the radiculopathy has begun.  

So, what often happens is  this: People will incorrectly assume that muscles are the cause of the neck stiffness /shoulder stiffness and go for a massage or physio therapy. Many times the patient will point to a "general" area  and it's generally localized pain. Sound like you?

The C5-C6 nerve root starts in the low neck and works it's way to the deltoid muscles. The root is above the C5 and C6 vertebrae.

The C8 Nerve root is located right in between the shoulder blades. Since there is NO C8 vertebrae, the vertebrae responsible for the C8 nerve would be below the C7 vertebrae. C7 and /or T1 adjustments often take care of that radiculopathy. 

Sometimes the pain is DIRECT and the patient
can feel it right on the spinous process. That pain is usually at the levels of T3 and T4. An adjustment below those vertebrae will take care
of that pain.

NECK stiffness and pain also can be due to a radiculopathy.

The most common levels of root involvement are C6 and C7; high cervical radiculopathies are less common, but do occur:(C2-C4)
Many people come to the clinic with these common Signs/Symptoms: Do any of these sound familiar? 

Posterior head ache (Occipital headache/suboccipital), temporal pain.  : C2

Suboccipital Headache/ pain behind the eyes, pain behind the ears:       C3

Traps, upper shoulder pain, Base of the neck :                                        C4

Sides of the Upper arm. (deltoid mm):                                                       C5

Forearm pain, Pain in the Thumb and the Index finger:                            C6

Middle Finger Pain:                                                                                   C7

Last two fingers Pain :                                                                               C8

Hypothenar and Medial side of the arm up to the elbow:                          T1

This is why it is very important that the doctor know exactly what symptoms you are feeling. This will better help him to remove any radiculopathies and to restore your health as quickly as possible.

A cervical radiculopathy= Neurological problems with a loss of neurologic functions.
Patients will experience a combination of  : 
1)sensory loss
2) motor loss (weakness)....... or
3) impaired reflexes( in a segmental distribution).

The sensory disturbances are often in a dermatome pattern. this does not necessarily mean that pain has to be along that dermatomes,  In many occasions the pain responses will mask as either facet syndrome or disc pain....this is what separates RADIATING pain from a radiculopahty.  

Radicular Pain and Radiculopathy Definition

Radicular pain(aka radiating pain) is a type of pain that radiates into the extremities directly along the course of a spinal nerve root. Radicular pain is caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis. Leg pain can be accompanied by numbness and tingling, muscle weakness and loss of reflexes. The most common symptom of radicular pain is usually called sciatica or sometimes radiculopathy, which is pain that radiates along the sciatic nerve down the back of the thigh and sometimes into the calf and foot.
Radicular pain, the characteristic symptom of cervical radiculopathy, is often confused with a radiculopathy in clinical practice. Because specific treatments are exclusively indicated for radicular pain, an accurate distinction is important. True radicular pain follows dermatomal patterns and is usually— though not always— unilateral. Onset is often insidious but may also be abrupt, and the pain is frequently aggravated by arm position and extension or lateral rotation of the head.  
RADICULAR PAIN/RADIATING PAIN: is from a specific point or origin and follows a specific path (down the legs, down the arm). Facet syndrome or disc involvement not a radiculopathy. Understand? 

So, how do these radiculopathies occur? One of the reasonis is work ergonomics. What? Yes, your work place. Stress, lack of a head set for those on the phone all day, people on the computer for hours and hours.  Improper positioning of a keyboard, improper keyboards that create ulnar deviation. Positioning of the monitor, how high the chair is set. The type of chair,....and many many more.

Ergonomic issues have increased due to long work hours, lap top computers, and the amount of stress the job entails. I have many patients from one particular company that always appear to have the same issues. Intrascapular stiffness and pain. Pain in between the shoulder blades and pain below the shoulder.  The issue I have with this is that the patients from this company are "limited" on the amount of chiropractic care  or medical care they can have. The amount is directly dependent upon the amount of salary they make. Does that make a lot of sense to you?...........So, these are the hard working employees who truly don't get to experience the true benefits of chiropractic because they use chiropractic simply as a "pain relief" clinic. Many do no get to experience structural repair, biomechanical repositioning, or long term affects of chiropractic because they are constantly caught in this "rat mill" of insurance limitations. In addition, many of the patients are not motivated enough to do anything outside of the clinic that would promote their wellness or well being. So, it's a double edged sword. 

However, that being said, there is one patient from that particular office that did manage to restructure his spine and create muscular balance. This picture you see,....only took this patient 3 months.

Unfortunately, as I told you prior this patient recently told me that since his " insurance " benefit is up at work, they will not be able to come to clinic for the next 3-4 months. So, we certainly hope this patient continues on this path of success. He certainly worked hard at it.

So,... this comes to the second way radiculopathies occur.... POSTURE....Bad posture leads to bad health. As simple as that.

Let us review the basics to many postural problems.
1) A subluxation occurs in the body and the body recognizes that subluxation, and over a period of time, that "LOAD" or structural mechanical stress becomes too much for the body, so it creates a postural shift. In addition, the musculature changes as well. Your
overbearing one side and therefore will create tight muscles on one side and weak muscles on the other.  Sometimes, I will get people come into my clinic and they will say, "but,...I feel no pain, so I must be okay. THESE people don't wish to understand what their body is truly going through. They are merely looking for justification that "they're alright" so they can continue living the life they have been living, and then they can say,..."but the doctor told me I was alright". Putting the blame or burden on the doctor for THEIR decreased quality of life and not taking on any responsibility themselves. These are the PAIN patients.

I am now going to post a few postural pics, of prospects who never became patients or PAIN patients. The prospects often INSISTED that they were " JUST FINE", the pain patients were looking for a "miracle pill", and chiropractic certainly isn't that.
So,.......You make the call...Do these people look fine to you? If you say "yes", need new glasses.

This women has moderate to sever scoliosis. Pain every single day.  She is under 30 years of age. In addition to her scoliosis let's review this posture?
* Left shoulder is high
* High Left hip
* anterior shoulders
* left thoracic rotation (look how the left hand you can no longer see)
* Left posterior pelvic rotation
* Right head lateral flexion (partly due to her scoliosis)

I told this person about the fact that pinched/pressured nerves in her body are throughout her spine. Where there is a decreased amount of nerve flow transmission to that part of the body where the nerves are supposed to go to, will mean she will have issues later on in life.............She didn't believe me........Ignorance is bliss. She will continue to have difficulty throughout her entire life without proper chiropractic care.

Now,...let's look at this guy. His posture is AWFUL.

* Anterior Head Translation
* Bilateral Anterior Shoulders
* Posterior Pelvis
* Right foot flair

"But Doc,...I don't see or feel any pain?".........You will, will.

Now, this person actually became a patient, but was expecting a miracle.  Do you think this posture happened overnight? No way! This took years and years to get this way.

* Left thoracic shift
* High Right shoulder
* Anterior Pelvis
* Right foot flair
* Muscular imbalance

Some of the issues is that the patient thinks chiropractic is merely a "therapy"...not understanding it's a way of life. So,  "GET ME OUT OF PAIN" is their only goal.
That often occurs,..but, as I tell every patient,........that pain will return quite easily after the adjustment. For they haven't done anything structurally to change that. Musculature imbalance,  postural re-training, soft tissue repair, establishing ligament laxity to allow postural re-training,.......Do you think this guy had a lot of shoulder stiffness and low back pain? YOU BET!!!!.......He'll be caught on that proverbial wheel of ointments, medications, massages the rest of his life for impatience and lack of willingness to work at his posture is evident.

Oh, is one of my favorites. This young boy is a MESS.  Let's review his posture.

* High right shoulder
* anterior rotation of Left shoulder
* bilateral shoulders have gone anterior and inferior
* valgus knees
* (YOU cannot see) flat feet
* Anterior head translation
* head translation
* widened stance
* hyperlordosis
*anterior pelvis
* Obesity
You can see head lateral flexion, spinous rotation, left convexity of  the cervical spine.
Think this patient had intrascapular pain? You betcha!

 You can see hyperlordosis and anterior pelvic rotation


You can see high right shoulder, thoracic re positioning.

With all of these issues, there was ZERO importance of trying to restructure his spine. This teen-ager will have serious difficulty as an adult. His body is speaking to him and his family and he don't see an urgency because he's NOT IN PAIN.

The Posture is the Window to your health. If your posture looks horrific, what do you think the possibility is that your health is not good also? 100%

When you start thinking about whether or not your health is being affected, look at the posture first? What does your posture say to you? If you think standing in an improper fashion is "normal",...then you are kidding yourself, and as long as you cannot admit the truth, you'll never be able to truly improve your health.

Dr. G