Iliopsoas Muscular Tightness Directly Causing Back Pain

First off…let me say,…"hello, again.". I have taken off a long time between posts. For one,… I no longer am a chiropractor at C-F….,but I was fortunate enough and blessed enough to have the opportunity to open my own clinic called Vida Wellness Center.

Because I have had so many patients and people just browsing looking at the posts, I won't bother fiddling with the URL,…I'll continue to post here….for now before I decide to transfer everything over to my own website where everything will be all inclusive,…including these articles and reviews.

Okay,…today, I wish to speak about the Iliopsoas Muscle. I would like to say this is one of the most overlooked muscles in regards to back pain,……EVER!!!!!


Psoas Muscle is a hip and thigh flexor. Origin of the Psoas Major is the Transverse Process of T12 -L5  as well as the lateral aspects of the discs in between those corresponding vertebrae. It inserts by way of the continued Iliopsoas Muscle into the  Femur bone of the Lesser Trochanter. Nerve innervation is the Lumbar Plexus vis the Anterior branches of L1-L3.

I often will find that when reviewing the patient's x-rays, the shadow of the psoas major mms. What you will also find is the the vertebrae starting to convex toward that side. Patients think it is scoliosis, but it is not. When a patient gets put on an exercise protocol of stretching out their Iliospoas muscles as well as their quadratus lumborum,…the pain will discipate within a few weeks (or less).  The doctor will adjust the lumbar region in the proper manner along with the patient doing in clinic exercises and the patient quickly restores to their normal well being.

The more prevalent the shadow the tighter the iliopsoas/psoas mm are.

The path of the muscle starts as the psoas muscle and once it reaches the pelvis it becomes the iliacus ms. and then those two muscles become the iliopsoas muscle.

Whether or not the spine "slinky's" back into it's normal position depends upon the coupling dysfunction. How much did the vertebrae move and the positioning of the vertebrae. However, with complete restoration or not, the patient can STILL get out of pain. Yay!!! So, no need to panic…just combine chiropractic with your stretches and you'll be out of pain in a short manner.

Dr. G

Does It Really Take 6 months To A Year To Heal?

There are many protocols out there that have patients come 3x a week from 6 Months to a year. What I have found is this: If you are doing that protocol, for some patients they may require it. It may actually take that long. But, there are problems that do occur with that protocol that most often make this system ineffective.
1) Most patients don't start holding their adjustment  for 2-3 days with that protocol until the middle of month 2. Most patients, if they come in with pain, aren't going to wait that long before they START to see results. 

Let's go with the facts first.
A) We know that "healing is by momentum". You can't come once a week and expect any type of substantial results,....if any. Sure, it feels good, and you are there to remove the pain. But, what happens is the patient and doctor have delved into the same allopathic philosophy that chiropractors have been longing to avoid. That being: "treating the symptom not the cause". With many patients, they will try to control the situation of coming to the clinic regularly due to: (financial restraints, laziness, boredom, etc...), but if the doctor doesn't fully explain this, they will lose all patients to this allopathic way of: Treating the symptom, not the cause.

B) No matter how well a patient thinks they are, if they have never been adjusted, a first adjustment never holds for more than a few hours. Sometimes less than that. Why? Well, first of all, half the patients that come in are often resistant to an adjustment, thereby the adjustment falls back quickly. Many patients have moderate to severe postural distortion,...and nothing has been done to correct that, so is the patient going to be corrected overnight? Not even close. Lastly, an adjustment needs to be "trained" in order to hold it's position.

So, let's go back to this 3x a week adjustment mode of thinking. If an adjustment barely lasts, then by the 3rd week, the patient starts to get thoughts of "doubt". Wouldn't you? I would. I go in to see the chiropractor and the pain continually returns? Ah....this stuff doesn't work.  So, what needs to be done is what I am doing in my clinic now.

2x > 1x > 2x : 5x a week for 3 weeks. (2x on Monday, 1x on Wednesday, 2x on Friday) For most patients, in fact, for all the patients that I have done this with in the past 4 months, I've NEVER had it NOT work.
1) Patients start seeing immediate results.
2) Doctor is able to properly score the patient and see how long the adjustments hold, and what muscles need to be worked on, what ligaments need to be stretched, what postural work needs to be focused on, and what part of the body tends to be subluxated the fastest.

1x > 2x > 1x: 4x a week for 3 weeks. Patient has already started to show improvement, and now the doctor and patient can work cohesively together to get the posture correct, and work on exercises and training that will allow the adjustments to hold even longer.

1x > 1x > 1x: 3x a week for 3 weeks. Patient has seen the results extremely quickly. It doesn't matter if the patient has a radiculopathy, scoliosis, low back pain, neck and intrascapular pain and stiffness. They're all seeing results.
One of the things a patient needs to see is POSITIVE RESULTS. I have on occasion skipped step #2 and gone straight to this step if the patient is really progressing quickly. It depends on the patients progress, however,

!x > 1x: 2x a week for 3 weeks. This is the final step in a 3 month process that gets a patient better in a more timely manner than 6 months or a year.

After this, the patient has the choice. They can come 1x/weekly, 1x/two weeks,  1x/ 10 days, or 1x/monthly. It depends on many factors, usually these factors are decided upon by the patient do to their desire to continue with their health. But, that isn't the doctors decision. They did their job.
a) Got the patient well
b) educated the patient on how to prevent their pain/stiffness to return.
c) educated the patient on how to maintain their spine and the importance of chiropractic.
d) educated the patient on how to minimize pain if it does return.
e) educated the patient on the CAUSE of their problem and the reason for the problem in the first place. (This doesn't mean we have a crystal ball,... this simply means the doctor did a good enough diagnosis and treatment plan, that the patient was able to understand completely what was going on with their body).

Back to why 3x a week is "old school ".

2) Patient impatience: Many patients to this day believe that chiropractic is a "pain relief" system of therapy,...until they come in my clinic. Many believe it even after they are told repeatedly, otherwise. So, the way they remember is by seeing results. You can preach to the choir, but if you get no results, then when preach? A doctor MUST remember that even when they educate, they MUST remove the problem (chief complaint of the patient) first!. IT'S AN ABSOLUTE MUST! Patients will be more patient with you and your teaching if this occurs.

3) No patient in their right mind can clear their schedule for 6 months to a year for chiropractic care. A chiropractor would be insane to think that. Patients have business trips, vacations, sickness, kids, family obligations, non-expected emergencies.......way too many to even write down.  This is why most never complete the 6 month - 1 year/ 3x week process. I have been fortunate that most of my patients will give me 3 months. Even the ones that cannot, when they return from their obligations, they return without any issues because they saw the results, and they feel the need for an adjustment once they've been away. They are starting to recognize their own body.

4) WLP: Waiting List Practice: a C.J. Mertz program in keeping a successful practice. I remember a chiropractic practice in Singapore that ran this program to a tee! SO much so, there were "memorized" scripts that were told to every patient, regardless of the issue the patient came in with. The problem with this way of practicing is the practice turns into a duplication of the "car salesman industry". When a person buys a car, often what they fathom is the whole process of buying a car and dealing with the car salesman, and gnarling back and forth between themselves and the salesman. It has NOTHING to do with the car. They love the car. The car is what they came in for, but it's the bullsh*t they have to deal with while trying to make a purchase that makes them cringe. Same with this WLP system. Nothing wrong with chiropractic, but it's the bologna they have to deal with and not knowing what is truthful and what is not, that turns the patient against chiropractic completely. I COMPLETELY AGREE. This form of chiropractic doesn't keep a patient longterm. 

In my clinic, we are upfront in what they need,.....every patient is treated differently. From the style of adjustment, to the treatment plan, to the observation method, to the exercises given. All of it. And guess what? Patients often return and many have been my patients for a long long time. Many giving referrals. Think about it,.......if you bought a car from a place and you HATED the service or sales department, would you recommend that place again? HELL NO! Same here. You may get well, but you won't recommend the place again, and you'll bow out as soon as possible. So, there are clinics in America, Canada, Europe and Asia that are running this system. (Including Singapore and Indonesia).

I talk about "momentum in healing" quite a bit. I want you to picture a bunch of people pushing a car. When does it take the most energy? When does it take the most force? When does it take the most momentum? At the beginning when there is little results or when the car is finally rolling?

In this image above. The asserted energy is used while the car is stuck in the snow. Once the car gets rolling, everyone hops back into the car and rides along the road with ease. Same thing for chiropractic. The momentum is at the beginning. The most adjustments, the most work is in the first 12  weeks. Once that momentum is built, then simple maintenance is all that is needed. Simple as that!!!!!

Good Health,

Dr. G

Toxic Reaction After A Chiropractic Adjustment

I am first going to tell you something I inform every single one of my patients BEFORE their first adjustment.

YOU COULD GET SICK. Now, it isn't the doctor that made you sick, or the adjustment itself. However, if the doctor doesn't inform you of this and WHY it occurs, what else is a person to think?

Toxic relief. This is the experience that approximately 15-20% of the patience experience after their first chiropractic adjustment.

What are the symptoms? Well, I am going to go over the most common symptoms first, then go over what the rest of the symptoms we have seen in our clinic.

1) Lethargy: Patient within hours feels completely drained of energy. This isn't a sudden virus that attacked your body, it's your own body reacting to the chemical and electrical impulse the nerves send out to the body that were being denied regularly.

2) Headache: most often without fever. (This isn't a virus, but the body will look to fight what is going on).

3) Night time sweating: Profuse sweating (of course a loss of sleep). Body is looking to cool itself down.

What? Explain that again in layman's term Doc....  Your body sends out electrical and chemical impulses from the brain down the spinal cord 24 hours a day.

Before I go any further, I am going to attach a small synapses of nerve cells that both interestingly enough BOTH chiropractors and medical doctors agree upon.

Other S/Sx: eyes burning, loss of sensation of taste, difficulty breathing, diarrhea, ...and last (but very common...especially at the tail end of Toxic Relief)......very tight gastrocnemius muscles in the back of the leg.

The Nervous System: Composition and Organization

While our brains control nearly everything we do, the brain does not work alone. The brain is the central part of a complex body system known as the nervous system. The nervous system allows us to respond to the world around us. Both our involuntary actions, such as our blink reflex to bright light, as well as our voluntary actions, such as choosing to put on sunglasses, can be attributed to our nervous system. Such a system must necessarily be both complex and extraordinarily well organized to produce the coordinated functions that define human life. How does our nervous system manage to perform its various functions?

The nervous system is organized into two major subdivisions: the central nervous system (CNS) and the peripheral nervous system (PNS; Figure 1).^3,15 A brief examination of the nervous system’s components helps create a broader context in which to understand the brain and brain function.

The central nervous system (CNS).

The central nervous system consists of the brain and spinal cord. It is the major information-processing center of the body. The spinal cord conducts sensory information (information from the body) from the peripheral nervous system to the brain. After processing its many sensory inputs, the brain initiates motor outputs (coordinated mechanical responses) that are appropriate to the sensory input it receives. The spinal cord then carries this motor information from the brain through the PNS to various locations in the body (such as muscles and glands).

Not all of the body’s motor responses travel through the brain for processing. The spinal cord alone is able to direct simple reflex actions, such as the knee jerk reflex, that require a quick response from the body. More complex motor actions, such as some involuntary and all voluntary actions of the body, require brain involvement. The brain is both the integrator and director of information through our bodies. Our brain devotes most of its considerable volume, energy, and computational power to processing various sensory inputs from the body in order to determine and initiate appropriate, coordinated motor output to the body.

3.2 he peripheral nervous system (PNS).

The peripheral nervous system is composed of all nerve tissue outside the brain and spinal cord. The PNS delivers information between the body and the central nervous system. It is divided into two subsections: the sensory/somatic nervous system and the autonomic nervous system. The somatic nervous system carries messages between the CNS and the body’s sensory organs and voluntary muscles. It allows us to detect changes in the world around us, and it delivers information related to actions that we decide to perform. In contrast, the autonomic nervous system carries messages between the CNS and our internal organs. It delivers information related to automatic tasks such as the regulation of breathing and digestive functions.

Figure 2. A neuron is made up of a cell body, dendrites, and an axon. Dendrites bring information into the cell body; information travels through the axon and exits the cell through axon terminals.

Cells of the Nervous System

All components of the nervous system, including the brain, are composed of billions of specialized cells: neurons and glia. Though the two cell types work together to provide the coordinated functioning of the nervous system, the unique structure of each type of cell allows it to perform its specific function.

Neurons.

The neuron (Figure 2) is the basic functional unit of the nervous system. Its primary function is communication. Neurons receive information from cells, and then transmit this information to other cells. The transmission of information between cells of the body and neurons enables us to react to changes in our internal and external environments. Neurons have a cell body, which contains a nucleus that directs the cell’s activities. Specialized extensions called dendrites bring information into the cell body. Other extensions at the opposite end of the neuron are called axons. These carry information away from the cell body. Information leaves a neuron through axon terminals, the endpoints of the axon. Bundles of axons are called nerves.

The nervous system includes three general types of neurons: sensory neurons, interneurons, and motor neurons. Sensory neurons are specialized to detect stimuli from the environment, such as light, sound, taste, or pressure. Detection of a stimulus triggers the sensory neuron to transmit a message to the central nervous system. There, the message is relayed to interneurons that integrate the information and generate instructions about how to respond. Instructions are sent back to the peripheral nervous system as messages along motor neurons. The motor neurons then stimulate muscles to contract or relax to make the appropriate responses. They also stimulate glands to release hormones.

Figure 3. Specialized glial cells form myelin sheaths around the axons of neurons.

Our nervous system is able to pass a message from a sensory neuron, through several interneurons, to a motor neuron within several milliseconds. Though this seems very fast, some sensory inputs (such as pain) requires an even more rapid response. If we touch a hot stove, for instance, it is beneficial for us to pull back as quickly as possible. How does the nervous system handle this reflex response? When responding to input that requires a very fast response, our nervous system allows sensory neurons to relay information through only one interneuron, or to connect directly to motor neurons. By reducing the number of inter-neurons required for signal processing, reflex responses are able to occur more quickly than other responses. Reflex responses are discussed further in Section 6, The Spinal Cord.

 Glia.

Glial cells, collectively called glia, greatly outnumber neurons. Why do we need so many glia? The functions of glia, though not as well known as for neurons, are generally to serve as the support structure for our immense neural network.¹⁴ For instance, some glia form myelin, the insulating sheath that surrounds certain axons (Figure 3). Myelin keeps electrical signals contained within axons and enhances the conduction of electrical signals. Other glia are scavengers that remove debris after injury or neuronal death. Some glia guide the migration of neurons and direct the outgrowth of axons during development, while others facilitate communication between neurons.² Some glia may even serve to “feed” neurons, providing them with essential nutrients.

Figure 4. A nerve impulse is information (in the form of an electrical impulse) flowing through the dendrites, cell body, and axon of a neuron.

 Transmission of nerve impulses: electrical transmission.

Neurons send and receive messages to and from each other and the body. They do this through a two-part process called neural signaling. Neural signaling begins with the generation of an electrical impulse that is passed down the length of one neuron.

How does this work? An electrical impulse is generated when a stimulus (such as sensory input) causes a rapid change in electrical charge in one part of a neuron’s membrane. This electrical impulse is one unit of neural information. An electrical impulse flowing along the length of a neuron is called a nerve impulse.

Nerve impulses proceed in just one direction within a neuron—from the dendrites, through the cell body and axon, to the axon terminals (Figure 4). In addition, neurons produce nerve impulses in an all-or-nothing way. For example, if the stimulus that a neuron receives is too weak to trigger a nerve impulse, nothing happens—the neuron does not initiate an impulse. If the stimulus is strong enough or much stronger than the minimum required to trigger a nerve impulse, the neuron does initiate an impulse. However, the neuron does not initiate a stronger impulse in response to a more powerful stimulus. All that is required to initiate a nerve impulse is a minimum, or threshold, amount of stimulation. The frequency of nerve impulses, or the rate at which nerve impulses are initiated in a neuron, determines the intensity of the signal that travels through the neuron.

Okay... now that we have basic information on nerve cells and understand that BOTH a chemical and electrical impulse start from the brain and work it's way down the spinal cord and exit the CNS by way of the Dorsal Root Ganglia. From that point on it is called the PNS (Peripheral Nervous System).....

Why am I mentioning the DRG (dorsal root ganglia)? This is the area that the nerve exits and most importantly this is the area by the facet joint.......you know......the area where you feel the "crack", the area where you feel the "pop".........got it?

Now, imagine that the area where that DRG is pinched...Slightly or heavily....it doesn't matter......what this means is that the decreased amount of information from the brain to that nerve cell supplying that organ or muscle will be decreased. 

So? So what? What does that have to do with feeling tired? (Glad you asked). If you squeeze a garden hose,.........The faucet is turned on, the amount of water coming out of the hose is either minimal and if you squeeze the hose hard enough, no water will come out. Does this mean that the pressure from the hose has stopped? No,it is built up and starts to back up. 

So, now imagine this squeezed hose as your nervous system. If it's pinched and decreased amount of axonal information is being "bombarded" with electrical and chemical impulses...what do you think occurs? First of all your body will tell you things are wrong.

Pain, change of posture, constipation, appendicitis, gastric issues,....etc, etc, etc.

One thing you will find constant though is this. If you palpate that persons back where the nerve is pinched.....you'll actually feel heat. Not always pain,...because sometimes pain is the last thing you'll feel,... but you will feel diffuse heat. That heat is due to the blocked nerve flow transmittion  (again,...electrical and chemical impulses being bombarded at the DRG)

Dorsal Root Ganglia (in yellow)

Now, the fun part of my BLOG begins........I found an article someone wrote about their Chiropractic experience. Sounds like it wasn't positive. Why? Because the doctor never educated the patient of the possibilities of going through toxic relief.

I will underline the highlights in this article.

Chiropractic Adjustment: Risks of Chiropractic 

Neck Manipulation

My Unusual Reaction to Neck Manipulation

Jolynne Hudnell, Yahoo Contributor Network
Jul 13, 2009 "Share your voice on Yahoo websites. Start Here."

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My husband has a slight bulging disk in his back. We saw an ad sign on the road and decided to try chiropractic adjustment for his pain.

After a couple of sessions and a group learning session, the chiropractic workers offered me a free x-ray and exam. When someone offers something for free that may be useful, who am I to refuse?

I received my results immediately after the exam. I have scoliosis in two vertebrae in my mid to lower back (which my family physician discovered about 10 years ago). I was also informed that I have a reverse curve in my neck. And, of course, exaggerated and reverse curves in my back. All of these result in my poor posture. They spoke a lot about subluxations that cause problems. They recommended I receive chiropractic care at their office. As my insurance would cover this, I agreed.

The first chiropractic adjustment seemed to go great. It cracked and popped all the way from my neck down. It felt great when they cracked my back. My neck was different. The neck adjustments didn't really hurt, but it was a very odd feeling. Something just felt wrong about it. Being new to chiropractic care, I had never hear of risks of chiropractic neck manipulation.

By the time I got home, I felt drained. I took a nap. When I woke up about an hour later, I felt flushed and had chills. I took my temperature and it was 103 degrees. I assumed it was a virus. Possibly a flu. Over the course of the evening I developed the tell-tale aches and pains. For about 36 hours I had a fever, aches, pains, chills and fatigue. Then I was better. Good thing, it was time for my next chiropractic adjustment.

When I got there, I told them about my "virus". They acknowledged by saying a lot of their clients have had the same symptoms, though they didn't know the cause of those symptoms. They believed symptoms such as those would go away with further adjustments. I thought maybe toxins had been released from chiropractic neck manipulations dealing with the subluxations.

The back cracking was awesome, but again, the chiropractic neck manipulation just didn't feel right at all. I mentioned this. I was told it was because of the subluxations. Since I'm still not sure what a subluxation is, I was in no place to disagree.

As with the last time, when I got home I was so tired I thought I would pass out. Upon awakening, I had a fever again and developed the same symptoms for about 36 hours. Supposedly the body develops resistance to a flu virus. I highly doubted another flu virus would be around in the same geographical area at the same time of year that produced the exact same symptoms. Now I was concerned that the chiropractic neck manipulations were the culprit.

I canceled my next appointment, but attended with my husband for his. I had questions and wanted answers. How could the same negative experience happen after adjustment twice in a row? Were there risks of chiropractic neck manipulations?

This office had no answers. They offered no explanation for what I experienced twice after receiving chiropractic neck manipulation. The workers in this office defended chiropractic care to a point I almost felt like they were a part of some exotic cult or something. In my opinion, they could have at least come up with some reasoning of why the adjustments did this, such as the subluxations had released built up toxins into my body, causing such a weird negative reaction. I felt that may be what happened but they wouldn't even say that. They insisted zealously that chiropractic adjustments can't cause anything bad, but only good results. That's when my husband decided to stop going as well.

I spoke with my family physician about my fever and other issues following chiropractic adjustment, especially the neck manipulation. He said that although he's never heard of that specific reaction before, he doesn't doubt that there could be a correlation. His recommendation was that I do not have more chiropractic neck manipulation, but I could return for back care if I chose to.

After my experience, I researched for weeks trying to find out risks for chiropractic neck manipulation. I found no written evidence of a reaction even close to mine. I did find that there are a few cases of stroke linked to chiropractic neck manipulation.

According to the Chiropractic Stroke Awareness Group¹, chiropractic neck manipulation can cause one of the major arteries in your brain to tear resulting in stroke. This can happen if the neck is turned too far. It mainly occurs if a chiropractor is inexperienced or careless. A good chiropractor will check your neck and not turn it too far.

Many articles that argue lack of scientific evidence to support the claim that chiropractic adjustments can cause stroke are written by chiropractors or chiropractic organizations. They compare what they know with others in their field. One of these groups, The World Chiropractic Alliance², discovered that the risk of stroke from chiropractic neck manipulation is only 1-3 per million adjustments. That is a smaller risk than many other types of medical treatment for health conditions.

Other independent studies suggest otherwise. Stephen Barrett, M.D., for Quackwatch³, quotes a Canadian study that suggests the incidence of stroke caused by chiropractic adjustment is more like 1 in 100,000, but this is the only study I've found with a risk level that high.

You can find more information on a connection between stroke and chiropractic neck manipulation from the Chiropractic Stroke Awareness Organization⁴ and Neck911USA⁵. Remember, there has been no scientifically based studies to make a determination either way.

If you are concerned about your risks of chiropractic neck manipulation, be informed. Speak with your chiropractor about the potential for such risks. Ask about his or her experience and track record. As with any medical professional, they should be able to answer your questions to your satisfaction. Ask other clients and get their opinion. If necessary, ask your family physician and find a chiropractor who will listen and answer questions about risks of chiropractic neck manipulation.

NOTE: My situation was extremely rare. I have found no other person in literature who has had that reaction. It still could have been a release of the build-up of toxins. I will not go back to the office I was at since they acted like nothing was wrong and wouldn't answer my questions. Another chiropractor may have had the answers. As with any type of medical treatment, there can be risks with chiropractic neck manipulation. But chiropractic adjustments can be especially beneficial for many issues, especially for those individuals dealing with pain.

WOW!!!! This is a simple and normal reaction when it is not explained what can go on with the body.

Let's go over all of these things I underlined.

1) husband has a slight bulging disk in his back : A person having a bulging disk in their back is often referred to as a herniated nucleus pulposus...or HNP. It's actually safe for a chiropractic adjustment if the doctor explains that what they are doing is going above and below the affected area. Many doctors do not do biomechanical and kinesiological work, therefore the adjustment is FINAL.........I have apprehensions about that myself, for I believe in rotating the pelvis properly to increase or decrease the IVF (the hole that the nerve comes out of) thereby decreasing the mechanical stress on the body.

2)  decided to try chiropractic adjustment for his pain.: over 80% of the people come in for a pain related incident.  What is interesting is the "I"ll try" aspect of this comment. That is where the person starts to fail before they begin. Chiropractic isn't "I'll try" but rather, I'll switch my philosophy of thought and change my way of poor living.  The Pain they are experiencing is a symptom,...not the cause. With chiropractic, we are aiming to resolve the issues biomechanically, and allowing the body's restoration to complete healing all from within...........ADIO...Above> down> inside> out.  The flow pattern of how the body heals. Brain to spinal cord,

3)  I have scoliosis in two vertebrae in my mid to lower back (which my family physician discovered about 10 years ago). : Impossible. It is IMPOSSIBLE to have scoliosis on only 2 vertebrae. Very definition of scoliosis is lateral curvature of the spine 20 degrees or more. If she has 2 vertebrae that are misaligned, that is extremely possible, but never scoliosis. So, this patient was uninformed, or took information improperly.

4)  I was also informed that I have a reverse curve in my neck.: very common with people that work in front of the computer every single day. It is possible to reverse the cervical neck through at home exercises and chiropractic care. This is also very common among people who are lazy in nature, bad self-esteem, or those that have extremely bad posture.

5) The first chiropractic adjustment seemed to go great. It cracked and popped all the way from my neck down. It felt great when they cracked my back. My neck was different. : Very common reaction. A great proprioceptive feeling occurs during an adjustment, often fooling the patient into thinking "they are well". The fun has just begun for them.....How their body reacts to this adjustment will decipher how well they are.

6) Being new to chiropractic care,: This patient is telling us exactly what she needed to tell the doctor. In her case, apparently she did tell the doctor everything. She was simply looking for answers that were not given to her,...so she came up with her own analysis. Would you be any different? Of course not.

7) By the time I got home, I felt drained. I took a nap. When I woke up about an hour later, I felt flushed and had chills. I took my temperature and it was 103 degrees. I assumed it was a virus. : This toxic reaction occurrence happens more often than we think. Interestingly enough, as a doctor, it is hard to predict whom this reaction will occur in. I've had patients with a terrible looking spine that have a very small reacton. Vice versa also: patients who have a beautiful looking spine and they get sick as a dog. That is why I tell EVERY new patient that comes in the possibility of a toxic reaction. This way they are aware of it happening to them.

8)  Over the course of the evening I developed the tell-tale aches and pains. For about 36 hours I had a fever, aches, pains, chills and fatigue. Then I was better. Good thing, it was time for my next chiropractic adjustment. Everything was matter-of-factual here. A) She had a toxic reaction B) encouraged to return to the Chiropractors office for a follow up visit. Where the chiropractor and staff failed was in understanding what was happening to this woman, AND how to convey that message to her. So, she is going to come up with her own conclusions. She sought out an answer,...and will continue to seek out an answer (even if it's not the correct one), until she can justify her state of being. Makes sense to me.

9)  When I got there, I told them about my "virus". They acknowledged by saying a lot of their clients have had the same symptoms, though they didn't know the cause of those symptoms : THIS is the very reason that chiropractors are closing their clinic. They become uninformative > patient wants a truthful answer > the patient isn't satisfied with the response > Patient leaves the clinic (unhealthy and dissatisfied).

10) I thought maybe toxins had been released from chiropractic neck manipulations dealing with the subluxations. : OMG...the patient actually knew more than the staff!!! She suspected what was going on and yet the office made her feel as though "they were justifying chiropractic"...therefore leading the patient to believe that chiropractic was some sort of cult...........I'd have fired the entire staff on the spot if that was my clinic. FACT!!!

11)  As with the last time, when I got home I was so tired I thought I would pass out. Upon awakening, I had a fever again and developed the same symptoms for about 36 hours.  : Of course. Makes sense to me... Here's what I tell my patients.

"I'm going to let you know that you may or may NOT get a toxic reaction after today's adjustment.". I won't go over the numerous signs and symptoms that can occur, but I will go over a few of them. Painful muscles, headache, dizziness, neck stiffness,  night time sweating and diarrhea. If these symptoms occur,...don't panic. Take water and antioxidants. Why? Toxins are looking to attach on to either muscles or organs and water is the medium we'd like them to attach to. They attach to the oxygen molecules  and get flushed out of the body. This being said, it won't take care of all the toxins 100%. This is where antioxidants come in to play. They are like "garbage collectors". They will pick up the remaining free radicals in the body. Please take plenty of water and if you do get an uncomfortable reaction come see  the next morning. Your body will attempt to fight. This is good. As uncomfortable as it seems, we want your body to learn how to fight. Increase the ability of your immune system. If you absolutely must take a pain killer,...do so. It's not my recommended plan of attack, but we don't want to see you in pain either. If you get this reaction, see you tomorrow,...if not, see you in 2 days. Last, but not least. I have found over my experience that toxic reactions last about 3 weeks. Meaning, you may hate me for 3 weeks, but after that you'll feel better than you've felt in a long time. I can handle your ire  and disappointment with how you are feeling,...because I know if you listen to what I say, and come when you are told,...you will get better very soon. Any questions?"

Now,..do you think I get patients who are scared after that? Rarely!!!! If the patient is still afraid after that,  walk them through it ONE more time. They may have not paid attention to you. If they don't remember after that?.......then it's their fault for not understanding and taking the proper steps to minimize the painful results and to get well within that 3 week period. Our job is to educate not babysit. So, after that,...I simply move on.

12) Now I was concerned that the chiropractic neck manipulations were the culprit.: What else is she supposed to think? Can you blame her? She's looking for resolution to her problem.

13)  The workers in this office defended chiropractic care to a point I almost felt like they were a part of some exotic cult or something. In my opinion, they could have at least come up with some reasoning of why the adjustments did this, such as the subluxations had released built up toxins into my body, causing such a weird negative reaction. : Justification period. The employees are trying to justify their work place, but they have no clue why things are happening......so, the patient thinks odd things i.e. cult experiences and what not. Perfectly normal reaction for a patient.

14)According to the Chiropractic Stroke Awareness Group¹, chiropractic neck manipulation can cause one of the major arteries in your brain to tear resulting in stroke. This can happen if the neck is turned too far The patient is looking for answers. So, they google the hell out of the internet, until they can come up with a resolution. Sounds pretty good to me. I've done the same thing. Now,......what this patient is referring to is a VBAI. This is a Vertebral Basilar Arterial Insufficiency and although it is quite rare 1/4,000,000 cases , it does occur. It also only occurs with "rotary adjustments".  These are chiropractors that aren't specific in their adjustment and are merely looking to get "an audible"...or as the patient would say,....hear a crack or pop.  Although it is  a non specific adjustment style, this doesn't exclude the fact that it's a rotational adjustment rather than a cervical break. (cervical break...is used in a good term here. This refers to the lack of  cervical rotation,  a clean, crisp adjustment through the facet joint without giving the patient a "sliding  adjustment":(C0-C1) Occiput across the Atlas bone  creating an opportunity for tear of the vertebral artery. 

Social Networking and Smart Phones Cause Psychopathologies In Todays Youth

I have recently been put in the position as a parent of a 13 year old girl, of being confronted with the harsh realities of social media and smart phones. The reality is that children DO NOT need to have smart phones and endless non-parental usage of the internet.

The waterworks from our 13 year old preceded with a post tantrum of how 'we don't allow her space', or ' why must we know everything that goes on her life'...to further tantrums of letting her parents know  that she 'hates us'...whew,...parenting is hard.

Here is an idea of the asocial and benign behavior we have witnessed since attaining her iPhone 5 only 2 months ago.

1) Endless usage of the phone: Sneaking the phone under the covers when the iPhone is supposed to be in our room by 9pm or sneaking other smart phones, tablets around the house, in order to stay up all hours of the night communicating rather than sleeping or studying. Constant disappearances during our holiday in order to find WiFi or recharge her phone rather than enjoying our wonderful holiday.

2) Going on to unsafe social networking sites like: Ask.fm and getting a false sense of security or worse yet, people bullying on that site with harsh and derogatory comments to her,...and in return her harsh responses that are not taught or approved of at our home.

3) Grades have gone down: Interest in school has become secondary.

4) Lying: This isn't tolerated in our household for any reason.

For these varying reasons we have limited the usage to 3 hours a day, (originally thought of completely eliminating the phone,...but how would that be teaching her responsibility?) and we are willing to put up with the "wrath of a teenage daughter:"

What have I seen as a clinician that directly affects their health?

1) Reversal of a cervical curve in their neck. Kids,...yes,...KIDS are coming in as early as age 10 with neck pain and back pain. Before the computer age, you never saw children coming in with such severe bad posture due to computer use and/or smart phone usage. Let me break it down for you.

As the child plays on their phone all day, their head weight translates FORWARD, proprioceptively training the neck to actually reverse it's curve from a lordosis to a kyphotic neck. Their shoulders droop forward with their clavicle rotation also going into an Anterior and Inferior position (what parents refer to as SLOUCHING". Their kyphotic upper back T1-T5 start to become hyperkyphotic or flattened.

So, in doctor terminology here is the scenario:

ANTERIOR HEAD TRANSLATION >> ANTERIOR-INFERIOR CLAVICULAR ROTATION >> HYPERKYPHOSIS or MILITARY BACK (flattening of the kyphotic curve in their upper back).

Anterior head translation with the head stuck in flexion will translate the C1 posterior and superior decreasing the Occipital (C0) - Atlas (C1) space.....The C1 vertebrae has a ledge...so to speak, which allows the vertebral artery (carrying oxygenated blood to the brain) and the sub-occipital nerve to be pinched.

Side effects? Decreased arterial blood supply to the head can cause headaches, postural distortion, biomechanical dysfunction, lethargic behavior (tired due to decreased oxygen flow to the brain), decreased ability to function at school (concentration level decreases, ability to sustain attention).

Decreased nerve flow function to and from the Atlanto-Occipital junction (C0-C1) can cause :  disorders, build up of toxins around the dorsal root ganglia from decreased nerve flow, cerebral and cerebellar dysfunction due to decreased nerve function (with a plethora or disorders that accompany that).


So, to finalize, I would ask parents to take a more PROACTIVE approach to their children's usage of their tablets, iPads, iPhones, Samsung SIII, SIV, Note and other smart phones out there as well as being stringent upon allowing children to access unsafe applications/websites like ASK.FM (where anonymous people are finding personal information about your children and family). I think we can end up having children be healthier in the long run. I hope you all agree.

Dr. G

Should I use ICE or HEAT?

HEAT OR ICE ?

is a question that is brought up many times in the clinic. SO, we will try to simplify things to better assist you. Here we go...

1) HEAT is often used when you have an acute injury with inflammation. 

  * Inflammation, swelling: The ice is used to bring down the swelling as it will   shrink the blood
     vessels. General rule of thumb is 20 minutes of ice/ 2 hr's of off time. However, many people
     I see ice, will use thick towels where the sensation of "cold" doesn't even penetrate the affected
     area during that 20 minutes. I prefer to use "ice" not an ice pack,...if at all possible, and I prefer
     to have it in a freezer bag or a bag that your local grocer uses to put the ice in......... This allows
     ice to penetrate very quickly.

CBA(I)N: Cold>Burning>Achy>(Intense burning)>Numbness. CBAN is the mnemonic used, but the intruduction of Intense burning has been added as a phase between Achy and Numbness.
These are the 4 (5) stages of COLD. Many patients never get to that feeling in 20 minutes. Sometimes it takes 30-40 minutes for this to occur. During acute injuries I have put a patient with ice for 30 minutes,...adjust them,...have them immediately ice again,... then follow it up with a second adjustment.......and guess what?.......I'll ice them a 3rd time,....followed by their 3rd adjustment. What? Really?...Yes, during an acute injury that adjustment will not hold during a first and often second adjustment. And it definitely won't hold without an anti-inflammatory (ice).

2) Chronic conditions: pain recurs. Never seems to go away. IF THERE ISN'T ANY INFLAMMATION?>>>>>>> HEAT.

3) Exacerbating pain: Pain comes,goes away for a period of time, returns.  HEAT.


How long should one heat? 10-20 minutes of a heat pack. Many types of home remedies for heat. But, please don't put ointment on for heat? That is a superficial method of heat and a lazy man's way of using heat. Why not use a heating pad or a wet towel? Wet towel the heat is intense very early on, but the heat dies out quickly and it often requires assistance to have repeated switching of towels for a 10 minute period of time. Put some hot water in the heating pad, and wrap in a towel, and place on affected area.........PERFECT. Achieve several things here. Increasing blood flow to affected area, loosen muscles and affected ligaments.  Oh,...don't fall asleep with heat applied. We don't feel like having burned patients.

Moving the clinic

Epicentrum Walk, Lt. 3, Unit 3-17,
Jl. HR. Rasuna Said -Kuningan, Jakarta Selatan, Indonesia 12960

I know,...it's been a while since I've written. (bad me). I will start again shortly after the move of our clinic. I have so many things to talk about that should make many of you excited to read and come back and re-read for enjoyment.

Our clinic is moving from the 6th floor to the 3rd floor (approximately June 15th). We will SMS most of our patients and notify those with appointments of our move. Hope to see you there.
Again,......same building, same location,........just go down 2 floors (no fourth floor,....so only 2 floors down) to the 3rd floor. It's easily accessible to both the lift and the escalator. Cool eh?

See you soon.


Dr. G



P.S.  Just found out on 20/6/2013 that the EXPECTED date of moving is 10/JULY/2013...see you there.

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,...no".  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,...here'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