Thoughts from the Chiropractor

When working with new patients it is really important to set the proper expectation in regards to how long an adjustment will last.  Everyone feels great when they walk out the door due to the endorphin release from realigning vertebrae, but how will they feel that night, or the next morning?  Will their symptoms improve or not?  How long will the vertebrae stay in the proper position? 

After getting adjusted the first time, patients should expect that they will feel good overall walking out the door, with improved range of motion and often immediate symptom relief, but that is going to change over the next 24 hours (although you are probably going to sleep really well that first night).  When moving vertebra through chiropractic adjustments, the body’s natural response is to create inflammation in the areas that were worked on.  Depending on how strong the inflammatory response is, that inflammation will cause soreness in the joints, similar to the feeling after a hard workout at the gym.  As the inflammation decreases over the next 48 hours, the soreness will resolve itself.  If this is the first time that a bone has ever been moved, the inflammatory response is strong and there will be a good amount of soreness.  Over the first few weeks of getting adjusted, the inflammation and soreness should decrease as the body gets more familiar with the improved range of motion and alignment.  During this time, symptoms should be improving and hopefully resolve.  If the client is a maintenance patient that gets adjusted regularly, there will be a very small inflammatory response and minimal, if any, soreness.

The expectation in regards to how long the vertebra will stay in the proper position depends on how long the bone was out of place to begin with.  If the vertebra have been out of position for decades, then the bone will likely go back out of position almost immediately due to muscle memory, ligament tension, and wearing of the joints over the years.  Fortunately, the range of motion of the joint should have been improved which will allow the musculature and ligaments to start getting used to moving properly again.  The other aspect to how long a bone will maintain its position is what the patient is doing in their lifestyle.  If the bone moved out of position due to poor posture at work on the computer, and the patient goes right back to that poor posture after their adjustment, then they should expect the bone to move right back out of position.  As the doctor, my expectation is that every time I check someone, there will be bones out of position because the patient has been living their life.  Playing with kids, sleeping in funny positions, sports, injuries, poor posture; life is hard on you, which is why chiropractic is maintenance for your spine.   

The question of whether or not to go to a physical therapist or a chiropractor comes up more often than you might think.  Both healthcare professions aid in the body’s ability to recover from injury and help with the maintenance of normal bodily function in the long term, but what makes them different and which one should you go to?

Physical therapy is defined by the oxford dictionary as: the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery.

Chiropractic is defined as: a form of complementary medicine based on the diagnosis and manipulative treatment of misalignments of the joints, especially those of the spinal column, which are believed to cause other disorders by affecting the nerves, muscles, and organs.

Reading that definition, it sounds like the two professions are pretty in line with each other, and they really are!  Physical therapy has a primary focus in muscular rehabilitation through strengthening, stretching, and manual manipulation of the muscular system.  Chiropractic has a primary focus on the nervous system through working with the alignment of the spinal vertebrae that protect the spinal cord and nerves that exit between the vertebra.  Both professions will occasionally use modalities like heat, cold, ultrasound therapy, or other instruments to aid in accomplishing their primary goals. 

The question of which one should I go to, really is not an either/or thing because if the main goal is to help our body recover from injury and maintain its bodily functions, you should go to both!  The muscular system attaches to the bones and is controlled by our nerves, so if there is a problem with one system, it is going to create a problem with the other system.  For the best results you cannot treat one without also addressing the other. 

I have been practicing chiropractic for the past 12 years and have seen lots of different ways that chiropractic offices operate.  Some offices have lots of doctors; some only have one.  Some offices have a front desk person, billing specialist, and chiropractic assistants, while other offices operate with only the doctor and no staff.  Some offices are huge with a dozen treatment rooms while others may operate out of a mobile trailer.  One of the perks to being a chiropractor is that there are lots of different ways to run the business, and each way attracts different clientele. 

After working in several different models of offices, I found out a lot about the things that I loved, but just as much I learned about the things that I did not want to mimic in my own office.  The most obvious thing that I did not want to do was deal with health insurance.  The main reason that I chose not to take insurance is that your insurance company dictates your care without ever really knowing you.  They decide whether or not you need medical imaging and how many visits you get without knowing what conditions you have.  Treating someone based on what their insurance company is willing to pay for is not what is in the best interest of the patient.   The other main downside to insurance is that it is almost always more expensive than our payment model.  Insurance co pays average around $50 per visit while deductibles have skyrocketed to the thousands, sometimes even more than $10,000.    

Instead, a self-pay “membership” style is what I adopted.  This system allows you to pay a flat monthly fee for all of the visits that you need.  My recommendation is that healthy people get adjusted once per week for maintenance.  Under the average co-pay system, that would be between $200-$250 per month for care.  In my system it is only $110 per month with the perk of being able to come in even more often if you are having a bad week or get injured.  This way, patients come in when they actually need to, instead of wondering if their back hurts bad enough to warrant paying their $50 co pay.   

Take a second to think about your grandmother; the hump on her upper back, slumped over in her chair, unable to look up at the ceiling, shrunk 5 inches in height, dealing with osteoarthritis, bone spurring, degenerative disc disease, shortness of breath, and dwindling hormones.  Now think about your 12 year old daughter constantly looking down at her phone, slouching down in her chair at the dinner table, not standing up straight because she is taller than the other kids.  That daughter is going to turn into your grandmother if she doesn’t fix one very important thing:  Forward head posture.

Forward head posture in the medical world is not just leaning your head forward for a moment, it is when the structure on the inside shifts, resulting in sustained forward leaning of the head.  After hours per day, for years, the curvature of the spine in the neck starts to straighten out, and in more severe cases, starts curving in the opposite direction.  The weight of the head transitions from over the joints in the back of the spine, where it is designed to carry lots of weight, to over the discs in the front of the spine that are not designed to maintain that load.  As a result, the discs start to degenerate, decreasing in height, causing a smaller opening for the nerves to exit from the spine.  Then the discs start to bulge outward, butting up against the adjacent nerves, and causing radiculopathy and loss of function wherever those nerves go.  In extreme cases, this added pressure to the discs can cause enough damage that a hole opens in the side of the disc resulting in the material from the inside pushing out and causing even bigger problems (known as a herniation).  In response to the added weight over the discs, the body recognizes abnormal stress and attempts to fix the problem on its own.  It does this by building extra bone (“bone spurs” or spondylosis) in the areas of additional stress to try to fortify and strengthen the area.  It’s an awesome response but results in irritation to the joints, which we call arthritis. 

Beyond the disc degeneration and arthritis, prolonged forward head posture causes the ligament that runs down the front of the bones of the spine to shorten over time, which limits the body’s ability to regain normal positioning of the head.  Musculature imbalances accompany the new head position which can impede the flow of blood and nerve function to the upper extremities.  The strain to the muscles at the base of the skull can result in chronic headaches and the muscles of the upper back get over worked resulting in “carrying your stress” in that area.   

I know that it sounds extreme that one little thing like forward head posture can lead to the body breaking down, but it’s true.  Obviously there are a lot of other things that we need to do to stay healthy, but something as simple as maintaining proper posture makes one of the biggest differences in spinal health and subsequently, the health of the rest of your body.  Proper work space ergonomics, decreasing time staring down at your phone, and exercising the muscles that maintain proper posture are all things that you can do now to prevent, decrease, and even reverse forward head posture.  So when mom tells you to "sit up straight," at the dinner table, she is probably speaking from experience and you should listen to her!

Getting your spine adjusted is essential to the function of the nervous system and maintaining the structure that our musculature attaches to.  We were given 24 bones that surround and protect that nervous sytem so that we can bend and move.  Our bones move every day with our daily activities, therefore, getting adjusted on a regular schedule should become part of the maintenance of your body.  But what can you do at home to supplement your chiropractic adjustments and help your body function and heal as it should?

I am not going to re-invent the wheel here, the answer is exactly what we have been told for our whole lives; eat right, drink more water, exercise/stretch, and get enough rest.  It sounds simple, but with our busy schedules, it is far too easy to put the basic principles of self-care down the list of priorities.  My goal is to make those things easier for everyone, so here are my simple recommendation.

Eat better-  Better does not mean perfect.  If you are the person that can never eat a carbohydrate again and be happy, then more power to you, but most of us will have an extremely hard time doing that.  Instead, aim to reduce grains (bread, pasta, cereal, etc) and dairy (milk and cheese) which will help to decrease inflammation in the body and will likely have the added benefit of decreasing body weight, easing pressure on your joints.  When grocery shopping, stay on the outer perimeter of the store.  The aisles are primarily processed foods.  Your diet should be mostly meats, vegetables, and fruits.  When you screw up with your diet, make sure that it is the exception, not every other day.

Drink more water-  The old thinking was that we should drink 8 glasses of water per day, which is good for some people and not for others.  The way I want you to think about it is this; drink half of your body weight in ounces of water per day.  I weigh 200 pounds, which means I should be drinking 100 ounces of water per day.  That is a lot more than the 64 ounces of water that I would be getting from just 8 glasses.  This means you will be spending a little bit more time in the bathroom, especially when you first make the switch to drinking more, but your body will adjust.  Water means water, not sweet tea/coffee/tea/gatorade/juices/diet soda or any of the other excuses for water.

Exercise/stretch-  Keep this simple, we are not looking to become power lifters or marathon runners here.  Spend some time doing cardiovascular exercise (fast walking, jogging, running, biking, rowing, elliptical, swimming) 3 times per week for a minimum of 20 minutes.  If your heart rate is not getting elevated, then it is not achieving the desired outcome.  The goal behind cardio is not strength or weight loss, it is heart and lung health.  Do some form of strengthening (weights, bodyweight, resistance bands) 3 times per week, making sure to hit all of the major muscle groups.  Stretch as often as you can.  Several times per day.  If you stretch one side of your body, make sure to stretch the other side as well (left/right, front/back).  To make it easier, in your own living room, go on YouTube and do one of the million yoga videos that you can find and it likely will do a great job of getting you to stretch while also strengthening your stabilizing muscles.

Get enough rest-  This one is not rocket science, get more sleep.  Aim for 8 hours per night.  Go to bed earlier, there is no good reason to stay up until midnight.  Sleep in whatever position you get the best sleep in.  Sleep on whatever pillow/bed you get the best sleep on.  Your body needs rest to build itself back up.

If you can do better at these 4 things, your body will thank you and you can expect less discomfort and better function.

Questions about pain are a daily thing in chiropractic offices, and honestly, are very difficult to answer.  Pain manifests in everyone differently; numbness, tingling, radiating, sharp, dull, debilitating, headaches, hot, cold, cramping, weakness.  There are A LOT of different ways that we can be uncomfortable.  Some people have higher tolerance to pain than others, but no one, absolutely no one, wants to be in pain.  

Almost all people who walk through the door at chiropractic offices are there because they have something that hurts, so the question always gets asked, “how long is this going to last?”  It is a difficult question to answer, and most of the time, the answer is, “I don’t know.”  No one wants to hear that their doctor doesn’t know how long they will be in pain, but it is the truth.  Everybody is different, and everyone’s healing potential is different.  The 18 year old athlete recovers much faster than the 75 year old obese arthritic grandmother.  Disc bulges respond almost always the same while plantar fasciitis and tennis elbow never recover the way the text books would tell you.  You adjust one person expecting that it will take weeks for them to feel better, and they come in on their next visit raving that they feel like a million bucks.  Then the next person that you expect is going to do great takes triple the time to recover.  Then there are the people that you know will never be fully out of pain because of how much permanent damage they have done to their body through injuries, trauma, and arthritic changes.  These people you are trying to maximize whatever percentage of improvement their bodies are still capable of achieving.

Everyone is different, but the goal is always the same behind your adjustment.  If we can open up the communication from your brain to your body and free up nervous system function, your body is going to start to heal.  The amount of time that it takes to heal is often an unknown, but just like you, I want everyone to get better as fast as possible. 

Doing your part as the patient makes a HUGE difference when it comes to recovery.  Follow your visit frequency that your doctor recommends.  Eat a clean, anti-inflammatory diet (decrease or eliminate grains/breads/pasta, dairy, and highly processed foods).  Exercise 4-5 times per week (yoga, cardiovascular exercise, and weight training that is appropriate for your goals).  Avoid sitting for long periods of time.  Heat or ice to the area of complaint depending on what your doctor recommends.  Get enough rest.  All of these things are important for recovery from acute situations as well as keeping our bodies functioning how they were designed to.

If you do not understand what chiropractic really is, it is difficult to know when you should go to a chiropractor.  Do you wait until your back is killing you?  When you can’t get out of bed without excruciating pain in your back?  When you get a diagnosis of degenerative disc disease?  When you are in a car accident, or fall down the stairs?  Although all of these situations are absolutely times that you should go to the chiropractor, you should have gone to the chiropractor before things got this bad. 

Chiropractors love to say, “When is the best time to start chiropractic care?  The day you were born.  When is the next best time to start chiropractic care?  Today!” 

Chiropractic is about optimizing the brains communication with the rest of the body along the nervous system that runs inside the bones of the spine.  Better brain function is something that benefits everyone, all the time.  So despite how cheesy that saying by chiropractors is, it is completely true.  If you are alive, the best time to get your spine checked is as soon as possible so that your brain can start communicating with your body better, and you can start living life to your full potential!

People who have never been adjusted are usually nervous about letting someone work on their spine due to their fear that the adjustment might hurt.  That fear is understandable because they have never been adjusted, and most people have a healthy fear of the unknown. 

Moving the vertebrae of the spine through chiropractic adjustments looks barbaric in videos on YouTube, but in reality is done with light force and high speed.  That means that the push on the bone is not hard at all, it is just done quickly, so as to move the segment that the doctor is touching, instead of everything else around it.   The light force means that for almost everyone, getting adjusted is easy and comfortable. 

All that being said, there are times that patients come in the office in terrible discomfort BEFORE they get adjusted.  For those people, getting adjusted is not always a walk in the park.  As their condition improves, the adjustments should get more comfortable.

Along the lines of comfort with adjusting, patients should expect that they will experience soreness following their first few adjustments.  This soreness is due to the inflammation that is a result of moving vertebrae.  The new position of the bones results in different stresses on the musculature and ligaments, causing inflammation.  That inflammatory response becomes less as the body gets familiar with the new position of the bones and the new mobility that results from proper joint alignment.  A great analogy for this experience of soreness is working out at the gym for the first time.  If you haven’t been working out, the first few times you exercise, you will be sore, but if you continue, that soreness will decrease each workout until it is not a problem anymore.  It is the same with getting adjusted.

In closing, chiropractic adjustments are low force and should be comfortable for most people, and are only uncomfortable for those who are already in a lot of pain.

I have the pleasure of adjusting a lot of people in my office, but by far the most fulfilling and fun to work with are the children.  When I talk about this with people outside of the chiropractic world, it often surprises them that children would need to get adjusted.

First we have to remember that the main reason for adjusting anyone is to open up the pathway from the brain to the body so that the nervous system functions properly.  That is not just limited to people who are hurting, it is important for everyone.

Secondly, children’s bodies are growing rapidly and their brains are learning and building neural pathways much faster than when we are adults.  It makes sense that removing pressure from the nervous system helps their bodies to grow during the most important years of brain development.

Lastly, and maybe most obviously, kids put themselves through a lot of trauma.  I have a one and a half year old daughter who has just recently learned to walk, and that process had her falling down hundreds of times per day.  My four year old son is trying to keep up with his eight year old brother and falls off the monkey bars, trips over his soccer ball, wrestles with his brother, bumps his head against everything, and generally is just a crazy kid.  My eight year old is busy playing soccer, flag football, falling off his scooter or bike, and somehow managing to twist himself into a pretzel while laying on the couch watching television.  If you have been around kids for any amount of time, you know what I'm talking about.  Kids are hard on their bodies!  All of these traumas are part of kids having fun and learning how to use their bodies and are absolutely necessary for their development, but because of all this trauma, they should be getting their spines checked on a regular basis.

After reading this, hopefully you understand why it is even more important for kids to get checked and adjusted than adults.  Go get your kids checked!

First we have to define the difference between getting checked and getting adjusted.  Getting checked is having a chiropractor analyze your spine to see if bones are out of place.  Getting adjusted is the process of the chiropractor moving the bones from a misaligned position to their proper alignment.   

Answering how often should I get adjusted is easy; whenever there is a bone out of place, you should get adjusted. 

Answering how often to get checked is a bit more subjective.  When patients walk in my door in acute situations, it may require getting checked multiple times per week.  For the completely healthy individual who is seeking to maintain the health of their spine, I recommend getting checked once per week.  Bones move out of place because we are living our lives, playing sports, sitting with poor posture, driving our cars, sleeping in funny positions in our beds, and playing with our kids.  Because we do these things, our bones move.  We move a lot so we need to check our spines frequently to make sure they are ok.  If nothing is out of place, great, no adjustment.  The only way to know if our spines are out of place is to get them checked.   

To reiterate,

Everyone, from 1 minute old to 100 years old should get their spine checked once per week to make sure that everything is where it should be. 

You should get checked more frequently when injured or stressing your body more than normal.

 If vertebrae are out of place, adjust as needed.