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What to Look for in a Chiropractor

It’s safe to say that chiropractors as a whole get a bad wrap. The typical perception of a chiropractor is that your going to get your “back-cracked” and have to keep coming back for life. Listen there are good and bad people in every profession. So what makes a chiropractor good at what they do? How do you know you are getting the best conservative chiropractic care possible? And what makes a chiropractor different from a physical therapist?

Let’s start by discussing what to avoid.

When you go to a chiropractor or physical therapist understand that you do not need x-rays to see the curvature of your spine. Of course if you have acute trauma or suspect to progressive nerve compression get imaging. My point is that the curvature of your spine does not need to be seen on an image because at the end of the day, does is matter? Unless you have severe degeneration, fracture or pathology, your curvature of your spine has no influence on spine pain and function (you know Usain Bolt has scoliosis right!?).

You have heard me say this in the past but bones only move when a muscle influences the movement. This is no different in your spine. You usually see an abnormal curvature only if the muscles pulling on the spine are asymmetrical. So what do you do, rely on adjustments? NO. Rely on soft tissue work? NO. Influence symmetrical muscle pull by teaching the brain to control the muscles around the spine correctly? Yes.

Avoid soley band-aid care! Band-aid care is an adjustment, soft tissue work, dry needling and single joint exercises that don’t fix the root cause of the issue. We preach on this all the time. Look for someone that is working on changing the way you move so you do not have to rely on band-aid care the rest of your life. Band-aid care is nice to relieve painful symptoms but does not fix the overall problem. Yes I know, band-aid care feels good, but at some point your going to get tired paying for the same issue over and over.

Avoid being another protocol! Be wary if someone spells out your whole treatment plan from start to finish. I remember doing rehab after my elbow surgery when I was younger and every visit they would go to the computer, type in my “issue”, and out came a list of exercises that we did that day. Every person has different strategies to move AND has a different ideal pattern that they should be moving in. Treatment should vary in response to how your body chooses to adapt to the new movement strategies.

The goal of every practitioner should be to fix a problem long term. The best physical therapists and best chiropractors practice the same — they are going to use the best possible treatment strategies to help their patients. The problem is that the best is hard to find. In your search for chiropractors in charleston, sc, keep in mind that you are looking for someone who takes a look at the whole kinetic chain, someone who tailors treatment to your body and goals and someone who wants to fix the cause of your pain long term.

Here at The Rehab Docs, we understand how confusing it is when choosing a healthcare professional. We would love to help you make that decision by answering any questions you may have and to help you find the best chiropractic care possible.

Common Faulty Movement Patterns Involving The Low Back

As we have said in multiple other posts, pain is a warning sign. Low back pain is no exception. It tells us that something is not quite right. Many have likened the prevalence of low back pain to an epidemic. Why the sudden increase in low back pain?? There are many speculations as to the reason and ways to prevent. Here is my take:

We all know that America is only getting more technologically advanced. This is great except for the people who have jobs working primarily with technology. Technology has advanced the human experience dramatically in terms of mental stimulation. Physically the opposite is true, for the most part.

The sedentary lifestyle that has evolved is inevitable. Being in any position for a prolonged period of time forces adaptation to the position. One of life’s greatest gifts, adaptation, can also be a huge downfall for a human body. The process of adaptation usually only has efficiency in mind. This may be efficiency of mating, day-to-day operations, catching prey, survival, etc. Immediate efficiency does not take into account long term effects.

Technology has allowed for a more sedentary lifestyle. This has forced advantageous adaptations to facilitate this sedentary lifestyle. We are then very efficient at sitting at a desk, but then do not perform as well when we enter weekend warrior mode.

The adaptation that, in my opinion, caused this epidemic of low back pain is the lack of a stable core. A sedentary lifestyle influences increased tone in the same muscles that act as accessory inspiratory muscles. These muscles include pectoralis major and minor, sternocleidomastoid, serratus anterior and scalenes. Because of the increased tone and neurological sensitivity to these muscles, they are much more active in inspiration at rest. If our secondary respiration muscles become dominate (because of adaptation) we do not have to rely on our primary inspiration muscles to handle its full load. This means less contraction of the diaphragm and intercostals. If we cannot get into full contraction of our diaphragm, we cannot create the necessary intra-abdominal pressure to stabilize our core. Let’s talk about what a stable core means.

Most of us do not have a stable core, not only because of this adaptation to our prolonged positions, but because we don’t know what a stable core means anymore. A stable core is not a six pack. A stable core looks more like a baby’s belly. Can you picture that cute gut hanging over the diaper? We've added a picture above for reference. A baby is able to use descension of the diaphragm and eccentric tone of transversus abdominis and obliques to create intra-abdominal pressure to stabilize in a variety of positions. Ideal stabilization of your core should look more like the inflation of a balloon within your stomach. Rectus abdominis (our six pack muscles) and erectors (big muscles on either side of the spine running all the way up) on the other hand, only stabilizes us in the sagittal plane of motion, or front to back. If this compensation resides, we are then at a loss of stabilization in rotation, lateral flexion, and anywhere in between. Not only are we at a lack of stabilization with this compensation, we are in a strategy that increases compression on the lumbar spine, which means the discs and other associated joints.

Being able to stabilize the low back with use of intra-abdominal pressure allows us to create a sphere of stabilization. This allows us to not only use our limbs off of stability, but also transfer load from lower extremity to upper extremity. For this reason, creation of intra-abdominal pressure is massively important to weekend warriors and athletes alike.

Everyone hears about how important the core is to a healthy back and function. How many of you knew the correct way to stabilize your core? Lets try a test. Put one hand on your chest and one on your belly button. Take a big, deep breath in. What did you notice? Want to know ideal? Ideally, the top hand should not move at all and the bottom hand should be moving out with each deep breath in. Being able to create intra-abdominal pressure is the key. Being able to do this during functional movements takes stress and abuse off of the low back by relieving the compensating structures.

If you want to exit low back pain, limit future risk of low back pain, or maximize potential, this is a great place to start.

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.

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Knee Pain

Common Faulty Movement Patterns Involving the Knee

Everyone at some point in their life has had knee pain. Most commonly this pain is at the front of the knee and may hurt walking up and down stairs. Knee pain comes and goes but it is a huge sign that biomechanically something isn't right. The knee is considered a stable joint because its plane of motion is mostly in one direction. Muscles that surround “stable” joints have a unique ability to produce tremendous torque. Torque at a joint is simply movement in one direction in a period of time. The knee, for example, is able to extend very quickly and forcefully due to its “stable” joint position. Another way of saying this is that there is less variance of joint position so the muscles can fire maximally with one purpose. The only problem with this joint stability is that our muscles surrounding our knee are not very good at stabilizing joint position. This is usually because we are not often in “unstable” joint positions at the knee where the muscles are forced to stabilize.

The opposite is true at the hip and ankle. These joints have many planes of motion which force the muscles surrounding to stabilize at each joint position. The muscles surrounding these mobile joints are not as capable in providing torque, but rather are great at providing stiffness. This is because the muscles at these joints are forced to act as stabilizers more often on a daily basis. Stiffness is achieved when muscles from either the side of the joint (the antagonists) contract in synergy to provide less movement at the joint. Now don’t get confused, the muscles around the hip and ankle are not there to limit movement but rather stabilize the joint through a large range of motion. With this being said, there are many instances where different levels of torque and stiffness at each joint are needed simultaneously and independently. A problem occurs when range of motion or muscle control is lost. Let's say we have someone with anterior knee pain. Yes, most likely rectus femoris or your quad is tight. At this point you must ask, “Why is my quad tight?” This could be because of a lack of hip extension, a lack of dorsiflexion in the big toe (not kidding), or multiple other reasons. After this you must ask yourself, is this a joint problem or a motor control problem. Do you have the joint range of motion but not able to use the range of motion through a functional movement? Are you not able to get into glute extension because of a lack of a stable core and subsequent lumbar extension and anterior pelvic tilt? The point is that something simple such as knee pain cannot be simply looked at as overuse. Getting a massage, dry needling, stretching, or simple single joint exercises are not going to fix the cause of your problem. A biomechanical problem needs to be addressed by analyzing biomechanics, not chasing pain. The key to getting out of pain and staying out of pain is realizing the difference between the cause and source of pain. No one has to live with knee pain. Make sure you are getting the care you deserve and get back to doing the things you love to do.

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.

Dry Needling? No Way, I Hate Needles!

What is Dry Needling?

To put it simply, dry needling is another way to manage pain (remember managing pain does not fix the problem). It focuses on addressing trigger points. Trigger points are those “knots” you feel that cause pain. Sometimes the pain is localized to the area of the “knot” while other times the pain can be referred to other areas, ie. headaches.

What is a trigger point?

Think of it as a good thing in a poor functioning system. It is a neurological way of protecting a certain part of the body. If certain muscles around a joint are not moving and coordinating correctly, trigger points can be seen in muscles surrounding that joint.

Why are we getting rid of trigger points if they are a protective mechanism?

For one, getting rid of trigger points gets rid of pain, and people don’t like pain. If a trigger point is dissipated by dry needling but the function around the joint is not fixed, the trigger point will return most likely the same day. This is the problem with band-aid care. An adjustment and soft tissue work is great but if the function is not fixed the problem will not resolve (this is a soapbox for another time). The treatment should be creating ideal function around the joint which in turn gets rid of trigger points and pain. Dry needling and other manual therapies should be used as an adjunct to creating proper function. Using manual therapies alone may feel good but is a waste of time for the patient in the long run as their problems will not be fixed.

Why dry needling?

Dry needling is the easiest way to address stubborn trigger points. Dry needling combined with adjustments is the best way to get these muscles to immediately relax. To get the most out of a treatment sometimes it is wise to get rid of the trigger points before changing motor patterns, or the way you move. This all depends on patient presentation including pain presentation and ability. Once again, needling of any kind does not fix the problem but should be used as an adjunct to fixing biomechanical fault.

How does dry needling work?

Dry needling works by disrupting the constant neurological signaling causing the trigger point. This disruption of signaling is because of multiple factors including increasing mechanoreception, damaging the motor end plate, manipulating fascia, increasing blood flow, increasing cortical awareness of the structure, or a combination of these.

Is dry needling for you?

If you have muscular pain (which a lot of times is because of trigger points), then yes!- but only in the correct context! At The Rehab Docs we use dry needling to facilitate the treatment process. It is a great tool if you use it correctly!

This site does not represent individualized professional medical advice. Please seek medical attention for any concerns regarding your personal health. Do not avoid, delay, disregard professional medical advice, or delay seeking it because of something you read on this site. If you want to be evaluated and receive personalized treatment, please call the office or send us an email.