Is Your Chiropractor Addicting you to Crack?
Hey guys, Dr. Lell here writing you from the Sellwood neighborhood of Portland, Oregon. There are a LOT of Chiropractors here in Portland – probably more than there are Starbucks. That’s a lot of bone-crunching going on. Maybe if you sit quietly enough, you can hear the collective pops and cracks of people on their way to a healthier life with less pain. But is the pop that we all feel during an adjustment worth anything? Do you feel like it didn’t work unless you feel the crack? Is your chiropractor turning you into a…..crack addict?
What’s the pop and crack during an adjustment?
First – what is the snap, crack, and pop? Technically speaking (*pushes glasses up nose) it comes from fluid dynamics and the popping sound is called a cavitation. Since the 1970’s, it was thought that this sound was made by the collapse of air bubbles within the joint that is being moved during the adjustment. But newer evidence suggests is from the creation of air bubbles within that same space. I have NO clue what the significant difference is there but I’ll tell you as soon as I learn.
Is the Pop important?
Practically speaking – the cavitation (pop) is a side effect of the adjustment and does not indicate whether or not the adjustment was successful or not. When chiropractors adjust a joint (not just in the spine but from head to toe) they are doing it to restore motion and offer some proprioceptive input. Take what’s stuck and move it. Consider the following…
- Some people crack when they get adjusted, others don’t. But both the poppers and the non-poppers still get good results
- Some people get adjusted with instruments most commonly known by patients as “the clicker” or “the gun”. These instruments never cause cavitations but the patients that get adjusted like this still get great results.
- Gentle styles of adjusting (low force) don’t cause pops and can be just as effective as traditional adjustments for pain and mobility
- Some research says that the popping isn’t even coming from what’s being adjusted – it’s coming from somewhere else.
- Some joints “pop” even though there is no physically possible way they can because of their design (synovial joint vs fibrous joint vs cartilaginous joint)
Why does the pop feel better than no pop?
Why do we feel so much better when we hear and feel the pop? Well the research is out on this one. Some people would tell you that it’s in your mind. If your chiropractor keeps slamming you until you pop and then says things like “that was a good one” or “boy did that move” only if an audible release is heard and felt, then your brain is being primed to expect it and see that as a good outcome. That’s not to ‘poo-poo” on your Chiropractor if he does that because that way of thinking was the prevailing theory for a long, long time. The research suggesting otherwise is pretty new and is just making its way into schools curriculums.
Another thing to consider is that spinal manipulation is good for all sorts of things – not just for mechanical pain. The studies that say “no crack is just as good as crack” are looking at how it affects PAIN. They aren’t considering the other mechanisms that spinal manipulative therapy is said to have.
I tell each of my patients that it’s my goal to make a joint work better. You may pop. You may not. So long as I restore the motion and you feel better at the end of the day, I’m fine either way.
Chiropractic adjustments are amazing at reducing pain, inflammation, and improving biomechanical function. No doubt about that. But the adjustment is not all about the crack. Get chiropractic care but don’t be a crack addict.
As always, drop me a line with any questions, comments, or if you’d like me to write about something specific.
Until next time, eat well and move often.
How Chiropractic can help Your Period Migraine
Hey guys, it’s your favorite Chiropractor, Dr. Lell. Today I want to talk to you about…
Your period, Your Period Migraine, and how Chiropractic can Help.
The International Headache Society (I bet those guys are fun) defines a migraine as a common disabling primary headache disorder. And they’re usually accompanied with sensitivity to light, sound, and nausea. They can occur with or without aura. A migrainous aura is a signal that you’re about to be in a world of hurt. It announces that the migraine is coming. Usually, the aura are little flecks of color or vision changes but it can be literally anything and people may have their own unique auras.
60% of migraineurs experience migraines during or around menses
Now no one knows what causes a migraine; chances are it’s a perfect storm of things mixing together. But there are many, many established links and triggers. A BIG trigger for migraines in women are hormonal changes. Of the 9 million women who suffer from migraines, 60% of them experience it during or around menses. This is especially problematic because perimenstrual migraines last longer, they’re more debilitating, and they’re harder to treat with meds.
82% of migraine sufferers also have same-sided neck stiffness or pain
Of the 60% of perimenstrual migraine sufferers, 82% of them report pain or stiffness in their neck, usually on the same side that the migraine will hit. Many women say they feel the neck symptoms first and they usually know that means a migraine is on its way. Is there a possible connection or link? A group of clinicians thought it was worth checking out and they developed a study to see whether or not dysfunction of the cervical spine added to the likelihood of a migraine for a woman on her period.
What causes cervical dysfunction?
- poor posture
- decreased cervical range of motion
- weak neck muscles
- tight neck muscles
- neural tension
- trigger points
- subluxations (joints that don’t move well or are “Out of Alignment”)
The Results
Which of these causes of cervical dysfunction are more likely cause or worsen a perimenstrual migraine?
- Decreased Range of Motion, especially rotation
- Muscle Tightness, especially in the upper traps, SCM, and suboccipitials (the muscles at the base of the skull) makes a woman 7x more likely to get a migraine.
- Trigger points in the upper traps makes a woman 6x more likely to get a migraine
- Neural Tension (a pinched nerve makes a woman 5.8-10x more likely to get a migraine.
- Subluxations (stiff joints) in the lower neck makes a woman 17x more likely to get a migraine
It’s hard to explain the why behind these findings without getting incredibly technical. But to boil it down, no one thinks the primary cause of a perimenstrual migraine is the musculoskeletal system. These dysfunctions add to the severity of the underlying hormonal causes (which include systemic inflammation from increased serum prostaglandins) because of some central nerve hubs located in the neck and closely associated with structures of the neck. In other words, the primary cause of the perimenstrual migraine is hormonal. The hormones are what’s causing the negative changes, but biomechanical dysfunctions in the neck amplify the negative effects of the hormones.
How Chiropractic can help with menstrual migraines
Chiropractors are the best choice in healthcare for treating biomechanical dysfunctions in the body. At my office, a menstrual migraine treatment program would include electrotherapy and soft tissue work to decrease trigger points and relax stiff muscles; chiropractic adjustments improve range of motion and decrease subluxations; and at-home neurodynamic stretches and exercises to decrease neural tension. This program addresses all of the dysfunctions proven to worsen menstrual migraines. By seeking care before and during your period, migraines can be greatly relieved.
If you’d like some help with your menstrual migraines, make an appointment online to see me in my Portland office. As always, drop me a line on Facebook with any questions or topic requests. Until next time, remember to eat well and move often.
Yours in health,
Dr. Lell
Core Exercises that WON’T Kill Your Lower Back
Hey guys, Dr. Lell here. When people want to work their core at the gym, they may start doing crunches (sit ups) on the floor or with a machine. I haven’t been to single gym here in Portland that doesn’t have one of those torture chairs for your abs. Crunches, outside of only targeting one muscle group of your core, have been shown to do a pretty bad job and even do more harm than good.
Why does the crunch fall short?
I know by now someone is saying that you can’t use the words crunch and sit up interchangeably. And that’s true. So I’ll approach each separately in this section. Both exercises only work the rectus abdominis which only represents a percentage of the your core musculature. Different people will have different opinions on what to include when they talk about core muscles. I tend to think of the rectus abdominis, internal/external obliques, transverse abdominis, diaphragm, multifidus, and the erector group. Some people go on to include the lats and muscles, quadratus lumborum, and muscles of the pelvis. Overdevelopment of only one group can lead to an imbalance eventually causing faulty and painful movement patterns.
The crunch is specifically underwhelming because it isolates such a small section of a very large muscle. Without using the entire muscle in its dynamic range, you can’t adequately strengthen it. You’ll recognize this in a lot of people who are always working their core because their mid-lower front stomach will be super toned but the rest is still kind of fluffy.
The sit up gives you more of a range but at the expense of your low back. The forward flexion with increased internal pressure creates the perfect environment for a bulging disc’s last thread to snap.
A good core routine should work most of the core while not promoting injury.
A better alternative
I like to start people off with just two exercises that are plenty challenging and do a fantastic job of toning the core while keeping your low back safe. They’re the plank and side bridge.
The plank
This is great not only for the core but for the quads, shoulders, and butt. Rest your weight on your elbows and toes. Your elbows should be under your shoulders. Your legs should be straight and shoulder’s width apart. Lift your butt up until it’s level with your head. You want your back from butt to head to be a straight line. Common mistake include lifting the butt too high or letting it drop – this is cheating and does more harm than good. I like to have people hold it for as long as they can slowly working their way up to 2 minutes. It’s also good to hold for 5-10 seconds and repeat three times until you can sustain it for at least 30s. If you’re more of an A/V learner, check out this YouTube Link. Once the plank can be held for 2 minutes, there are numerous ways to make it more challenging.
The side bridge
The side bridge picks up some of what the planks leave out. Get on your side. Rest your elbow not below your shoulder but a little closer in. Make sure your pelvis is straight (don’t be in the fetal position). Your legs should be straight with your top ankle just in front of your bottom (this is for stability. You can leave it on top if you’d like). Lift yourself off the ground and hold. You’ll notice that in the holding position, your elbow will be right under your shoulder (which is why you start off with it closer in). Try to not let your top shoulder roll over towards the floor – keep everything straight and in line. You can rest your unused arm on your side or reach for the ceiling. The same directions for reps/holding applies. If this is too difficult, you can bend your knees and use your knee as the contact point instead of your feet. If you’d like to see a video, check this out.
For those needing more structure and challenge, there are many good Pilates gyms here in Portland, especially Sellwood, and in Oregon City that I refer people to.
The benefits of a strong core
The core is central to your body and how your move. It should be strong and tight to protect the back, facilitate weight transfer, and allow for optimal motion. When the core is weak and doesn’t offer the stability that the body needs, the surrounding joints (hips and shoulders) tighten up which can lead to injury. I integrate core exercises into my treatment plan for every patient with chronic shoulder and hip issues and I see fantastic results that would not have been otherwise achieved just by treating the shoulder. If you’re doing crunches or sit-ups, try these instead and see how much of a difference they can make!
Until next time, eat well and move often.
Yours in good health,
Dr. Lell
PHOTO CREDITS
http://www.washingtonian.com/blogs/wellbeing/fit-check/5-core-strengthening-plank-exercises.php
http://www.theptdoctor.com/backstrengthening-exercises/
Questions about this post?
Dr. Lell would be happy to answer questions or provide more information discussed in this blog post. Contact him through our Contact Page.
3 Reasons why you have morning back pain or stiffness
Hey everyone, Dr. Lell here from not-so-sunny Portland. Though I have to admit, the days are getting a little longer, finally. It’s nice to be able to walk around Sellwood when I leave the clinic and still have some daylight to guide my steps. One thing that these darker days we’ve had brings is more sleep. It’s normal to sleep more during the winter months. The sun goes down earlier, our internal clocks kick in, and we’re in bed for 8:30. The increased mattress time for some folks can lead to more morning low back pain and stiffness than what they originally had. Some people have low back in the morning all the time; and that’s what this post it about. I’m answering the question “Hey Dr. Lell – why does my back hurt more in the morning?”
In most people, it’s from one of three things: an unhappy lumbar disc, a crappy night’s sleep, or arthritis.
1 – Morning Back Pain from a Lumbar Disc
People with discogenic low back pain (derangement, herniated disc, bulging disc) will often feel worse in the morning because of the hydrodynamic properties of the lumbar disc. The center of the disc is this water grabbing jelly. As the day goes on, your movements and your weight against gravity will compress the disc removing excess fluid. This takes some of the pressure off the pain sensitive outer-covering and neighboring muscles and nerves. During the night when you’re on your back, gravity is taken out of the equation (relatively) and your discs reabsorb some water making them a little larger by the time you wake up. That increased size can lead to reactionary muscle tightness, soreness, etc.
What are some other signs that you might have discogenic low back issue (outside of pain)? Chronically tight hamstrings, difficulty getting out of a chair or car, and back pain with certain motions are a few examples.
2 – Morning Back Pain from a Bad Night’s Sleep
Your back has these natural curves; directions they want to go in and where mechanical pressures and stresses are evenly distributed. Poor sleeping postures or a bad mattress can stress your spine in the wrong directions. When you sleep, the muscles that keep everything together and “in-line” are relaxed and this leaves your spine to rest on their ligaments. The body doesn’t like this very much and it’s natural reaction is to tighten up area musculature. Poor sleeping postures (on your side with a slanted hip, your stomach, etc.) work on the same principle. The best way to figure out if your mattress is causing your morning low back pain is to sleep on something else for a night. If you wake up refreshed and better, then it’s time for a new mattress. There are a lot of options out there but a guy who owned a few mattress stores in Portland and Oregon City once told me that the differences between them are just marketing. You can pretty much pick one at random and be fine.
3 – Morning Back Pain from Arthritis
One of the hallmark symptoms of arthritis (AKA Degenerative Joint Disease, DJD, and Osteoarthritis, OA) is morning stiffness that lasts for an hour or so until you get “warmed up” and moving. Arthritis is an inflammatory process and the swelling can occur overnight (swelling is a key part of inflammation). Unlike what we mentioned before, the swelling in OA occurs in the joint spaces – not within the disc. Either the synovium (joint covering) or the synovial fluid can increase in space/volume. The inflammatory process draws in more liquids and the lack of movement (because you’re sleeping) keeps them from getting pushed out sooner. DJD is a common problem, especially in older people, but that doesn’t mean it should be taken lightly. DJD is a disease process that usually only worsens and should be managed (because there is no cure) to ensure proper motion, function, and quality of life can be maintained throughout the years.
If you’ve been dealing with low back stiffness, make an appointment. Get it figured out, and start getting better. The morning is a fresh start to a new day; don’t begin it in pain.
As always, if you have a question, comment, or a request – drop me a line on Facebook! Until then, remember to eat well and move often.
Yours in good health,
Dr. Lell
Questions about this post?
Dr. Lell would be happy to answer questions or provide more information discussed in this blog post. Contact him through our Contact Page.
How Many Trips to the Chiropractor Does It Take?
Unlike a prescription drug, there are no “dose response’ guidelines for spinal manipulation (AKA the Chiropractic Adjustment). What’s a dose response? That’s how much of a medicine/treatment is required to see a change. Let’s say you have an infection. Take this pill three times a day for 7 days and the infection will clear up. The dose is 1 pill 3x/day for 7 days. The response is the infection being cured. Dose response.
There’s no easy formula for back or neck pain
We don’t have that in manual medicine because there are way too many variables. A person who is older, larger, or sicker will take longer to heal than someone who is younger and healthier. And everyone and every body responds a little bit differently. A chiropractor who doesn’t use exercise or electrotherapy won’t get results as quickly as one who does. Skill levels matter and so do injury types. A weekend warrior with a kinked back takes less visits to fix than someone who has been in a car crash. Some conditions like stenosis require long periods of regular care to keep symptoms under control. But even then, there are many Chiropractors here in Portland with diverse backgrounds and clinical beliefs. One person shopping for a chiropractor could get different answers for the same problem.
But the industry needs some general agreement or standardization so we rely on guidelines that tell us generally how long someone should need to be treated for an injury based on the kinds of structures injured (muscle, bone, tendon, ligament) and the severity of the injury (mild, moderate, severe). And someone with enough experience can typically give you a very close guess just based on your presentation. It’s been my experience that most “simple” things can be fixed in under three visits (if the goal is merely pain control) while a bad car accident could take between 3-12 months depending on the severity.
Some New Research from a Chiropractic School may help
Very recently, researches with the University of Western States here in Portland went out to see how many visits it would take to help someone with chronic low back pain. It’s the first study of its kind and it’s sure to have many implications on the industry. First, let’s define chronic low back pain (CLBP). CLBP is pain lasting longer than three months without any known cause. All the tissues are healed and there’s nothing that anyone can find that could be causing the pain. It’s just pain for pain’s sake.
They looked not only at pain levels but at function too. Because many people with CLBP don’t mind the pain if they can at least get back to doing what they love like hiking around Portland or riding their bike. What they found is that if adjustments were the ONLY treatment (no rehab, ultrasound, tens, etc.) then it would take 12 visits dished out at three times a week for four weeks to make the greatest effect on pain and function levels and the improvements were maintained for up to a year. Anything beyond 12 visits didn’t improve things to a greater degree. They also found that pain levels didn’t decrease little by little after each treatment but rather the levels dropped dramatically after six visits.
Whereas no one can say with any certainty that that your condition will be improved with X many visits, doctors can rely on industry guidelines and experience to offer an educated guess. In cases of chronic low back pain, the best educated guess is now about 12 visits at three times a week for four weeks but of course this will depend on a patient’s complicating factors and prior state of health.
Questions about this post?
Dr. Lell would be happy to answer questions or provide more information discussed in this blog post. Contact him through our Contact Page.
When Your Back Pain Needs to be Checked Out
Hey guys, Dr. Lell here. One thing I’m frequently asked is “when should I have my back pain checked out” and it’s a good question. Some chiropractors here in Portland would say immediately. But I liken this to taking your kid to the doctor every time he sneezes; it isn’t always necessary. Back pain happens. It comes, it goes (hopefully), and maybe it comes back. But there are things you can do to prevent recurring back pain like exercises and stretches. Read this post on my favorite daily stretches for more information.
Traumatic vs Random Back Pain
Now I’m not talking about back pain caused by a traumatic injury – that always needs to be checked out ASAP. I’m talking about the common garden-variety minor back pain that we all experience at some point. A lot of things contribute to it from a day in the garden and that old mattress to bacterial infections and stress.
“When does back pain go from something that you wait out to something you have checked out?”
My quick answer is 1 week. Random back pain that doesn’t randomly go away after 1 week needs to be checked out. That doesn’t mean that there’s something seriously wrong but it does deserve getting looked. This is because the back pain has the potential to get a lot worse if it hasn’t already gotten better.
Now don’t feel badly about going in sooner if you need to. When you have a big road trip coming up, if it’s affecting your job, or if you can’t take over the counter analgesics, then yeah – get checked out and end the pain early.
If your back pain is moderate or severe, consider getting in to your chiropractor sooner than later. If that back pain is accompanied by pain, numbness, or tingling in the leg – you should also get in to see your chiropractor as soon as you can.
In short, if you’ve been having back pain for longer than a week, consider making an appointment to get checked and to start feeling better.
Until next time, eat well and move often. If there’s something you’d like me to write about, drop me a line on Facebook or Twitter!
Questions about this post?
Dr. Lell would be happy to answer questions or provide more information discussed in this blog post. Contact him through our Contact Page.