The Art of Diagnosis

Full confession, I really do not like the word diagnosis. It is a little too limited, definitive, and stodgy for my tastes. I believe that we would be better served just identifying dysfunctional body parts than knowing fancy words that typically just describe symptoms. That saying, understanding symptoms and how they relate to dysfunctional body parts is extremely beneficial when coming up with treatment options. Understanding anatomy, biomechanics,  and physiology can make diagnosing musculoskeletal injuries so easy it is a wonder why most doctors get it wrong most of the time.

It is important to understand the location and type of symptoms to make a proper diagnosis. Location of symptoms does not necessarily indicate the location of dysfunction. Many dysfunctional body parts refer symptoms to other parts of the body. Luckily, there are patterns which come is handy for those clever enough to recognize those patterns. The type of symptoms tell a good doctor what kind of structure is dysfunctional.

Embryologically speaking, there are three types of structures: bone, consisting of bones, joints, ligaments, discs, and cartilage; muscle, consisting of muscles, tendons, and organs; and nerve, which encompasses tissues of the brain, spinal cord, cranial nerves, autonomic nerves, nerve roots, and peripheral nerves. Bone symptoms are typically described as a deep dull ache and can refer to other bone-like structures. Muscle is also an ache but feels more like fatigue and soreness. Muscle is more superficial and usually stays within the same structure. Nerve symptoms are more electrical in nature; numbness and tingling, just numbness, burning, shooting, etc. Nerves stay in the network of nerves. Knowing this will get you pretty far.

Consultation is the first step. I ask for the location and have the patient describe the symptoms. I also look for the mechanism of injury knowing that some structures are more likely to fail, depending on the stress placed on them, than others. With a good consultation, I have a fairly solid idea of what the problem is.

The second step is to do an exam. Bone structures cannot move themselves. For these tests, I do the movement on the patient checking for instability, pain, and altered movement. When I isolate joint movements, I can narrow down the location of dysfunction. Instability tests will suggest ligament issues (assuming we are not dumb enough to do a stability test on a complete fracture). X-ray is helpful to see fractures and degenerative changes. MRI is helpful to see disc bulges, ligament tears, and pathology. Repetitive movement works great for determining how to reform a bulged disc.

Muscles and tendons move bones. To test a muscle or tendon, resisting the muscle’s movement is an easy way to determine which muscle is injured. Why most doctors do not do this is baffling. Pain with resistance at the end of the muscle is usually tendon related and anywhere else is usually the muscle itself. If the type of pain is described as muscular but cannot be recreated with resisted movement, it could be an organ referring pain. Here again, repetitively resisting movement can really help determine how to help treat the injured structure.

Nerve symptoms require some specialized tests in the form of reflexes and sensation testing. True neurological injuries are very difficult to diagnose and to treat. In addition, any of the above can cause secondary and tertiary issues in other parts of the body, like muscles spasms or nerve pain due to encroachment with a disc herniation, for example.

Finally, one of the best ways to diagnose an issue is to treat the issue and see if it helps. Obviously, you cannot do this with everything, but as a chiropractor, I can do this for most injuries. Even a surgeon will tell you that nothing is definitive until they open you up and see it in real life. The point being, do not get too caught up with figuring out what something is before trying to treat it. Ruling out conditions is still valuable.

There you have it. Instead of plugging symptoms into WebMD to discover that you have a rare, incurable, terminal illness, just step back and look at the anatomy, physiology, and biomechanics of the body and go from there. Or, see your local chiropractor and let them help you through your issues or point you in the right direction. We spend a tremendous amount of time learning about all aspects of the human body.

**Photo by rawpixel on Unsplash


Chiropractic and the 3 Main Causes of Vertigo

vertigoIt could be the late cold season or a rampant allergy season, but I have had several patients come  in with vertigo this month. If you do not know what vertigo is, lucky you! If you have experienced the nauseating feeling of being on solid ground while your brain is telling you that the tilt-a-whirl is in full force, then you know that vertigo can seriously affect your life. Vertigo is described as a feeling of being stable while objects around you are spinning. The three systems that can cause vertigo, in order of most common to least, are the inner ear, the neck, and the brain stem.

  1. The Inner Ear has a complex system of tiny hairlike sensors, called cilia, that send information to the brain based on the movement of fluid through a maze of canals. When there is in an increase of fluid in the inner ear or the fluid gets too thick and mucousy, it affects the movement of the cilia, and can cause vertigo. This is common with inner ear infections, colds, flus, hay fever, and sinus infections. Drainage is critical to success in treating vertigo caused by inner ear congestion. Chiropractic adjustments help loosen the muscles in the neck which allows for freer lymph flow and better drainage. In addition, cranial adjustments can help pump the congested sinus and promote drainage. Drinking plenty of water will also help to thin the mucous which will help is drain.
  2. The Neck, especially the top two vertebrae called the atlas and the axis, respectively, have sensors in the joints called proprioceptors. Proprioceptors relay position to the brain.  They are found in all joints but the nerves in the neck are particularly sensitive to head movement. When these vertebrae do not move as they should, they send a mixed signal which can make the brain feel like the body is moving when it is not. Again, chiropractic adjustments will help reset proprioceptors which will restore the proper flow of position sense, thereby halting the vertigo.
  3. Brain Stem Dysfunction is by far the least treatable of the three. In general, brain injuries are extremely slow to heal. Depending on the nature of the injury, there is little hope of treatment save time and prayer. I have no empirical evidence, but I would imagine that hyperbaric therapy could be helpful. Chiropractic adjustments will not directly help but keeping the body and nervous system functioning well is always beneficial.

If you are suffering with vertigo, there are some easy, non-invasive tests to figure out which system is causing the symptoms. Treatment is effective and we usually see results pretty quickly in most cases.

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You Can Adjust the Bones in Your Skull?

There are 22 bones in the skull connected by a type of joint called a suture. In the old days, doctors thought these bones fused together in adulthood. Now, we know that they can and do move with some regularity. The suture as a joint is only found in the skull. It doesn’t pop like the synovial joints in our backs and extremities, they just shift a little here and there. Because there is movement, though, it can be adjusted, and because of the proximity to the brain, the results can be very beneficial.

There are several reasons people need the cranial bones adjusted. Most often it is due to a build-up of sinus pressure which changes the shape of the skull. The sinuses are open areas in the middle of cranial bones. They have a mucous lining and are sensitive to atmospheric changes. When full, as a result of a cold or allergies, they tend to hurt from the pressure. When one gets cranial bones adjusted, it regulates the pressure and promotes drainage into lower sinuses and into the lymphatic system.

Another reason to adjust the cranial bones is for TMJ issues that won’t resolve with adjusting the jaw. The “T” in TMJ stands for Temporal, as in the temporal bone. It makes the socket part of the joint where the mandible articulates. If it is shifted, the joint is not going to work right no matter how much you try to increase the movement of the mandible.

I have seen great success adjusting the cranial bones. It seems a little odd but it can make a difference. It can help with sinus issues, headaches, TMJ syndrome,  and a host of weird neurlogical conditions due to mild pressure on the brain.  Let me know if you want me to check it out.

10 Good Reasons to Use Chiropractic to Achieve Better Heatlth in 2010

It’s the last day of the year and people are starting to come up with New Year’s resolutions. I would venture to say that at least one resolution you have involves your health in some way. Let me give you 10 good reasons chiropractic should be included in your action plan.

1. Chiropractic helps control pain. Pain is a great de-motivator/distraction. When you get adjusted, you not only get an endorphine release but you also close down the nerve pathways that cause pain. This will allow you to work out with less pain.

2. Chiropractic improves joint function. Working out on joints that are not working properly can create worse problems.

3. Chiropractic improves balance. Balance is very important to good health. Getting adjusted regularly helps improve your balance. This is closely associated with proprioception which was the topic of the previous post.

4. Chiropractic will help improve your posture which will help you look and feel your best. Correcting the posture of the low back will especially help decrease the “pooch.”

5. Chiropractic improves nerve flow to the vital organs. When your organs are working properly your body will be healthier. This is especially true for the organs that deal with elimination of waste like the gut, the kidneys and the liver. When you get the gunk out you will be healthier. This is especially true after binging since Halloween.:)

6. Chiropractic improves hormone function. The thyroid gland controls metabolism and is critical to good health. In addition, balancing estrogen, testosterone, progesterone, etc. can make a huge difference in your energy.

7. Chiropractic is good for your feet. When you make that resolution to go running and your feet are killing you, we can help adjust the foot or do some soft tissue work to get you back out there.

8. Chiropractic can increase your lung capacity. When you get adjusted it allows the joints of and around the rib cage to be well lubricated and move freely. This allows proper inhalation and exhalation. Good breathing equals more oxygen which leads to more efficient cells and better health.

9. Chiropractic can help your sinuses. When you feel like you cannot breathe because the cold you caught just before Christmas just won’t go away, come in for some cranial adjusting and experience what it’s like to breathe through your nose again.

10. Chiropractic restores the body’s ability the work, heal, and function properly!

There you have it! 10 good reasons you should include chiropractic care in your goal to be healthier. See you soon!

3 Things to Help Your Allergies/Hay Fever

Let me just start off by saying that I have developed allergies in the last several years and I hate it! That saying, I have had a lot of success managing them with these 3 simple things.

1. Cleanse your gut. An allergy is an over reaction to an irritating foreign object. There are several theories as to why it overreacts. Once such theory is that the body is so inundated with junk that it is in a constant state of histamine reaction. Indeed, all of the dyes, preservatives, and fake substitutes have to be taking their toll. Cleansing the gut will help to settle down the fight and can dramatically decrease allergies. There are 101 ways to cleanse your gut. Here are a couple of ways:
If you want to go hard core this is what you do. Go to the health food store and
get the biggest bottle of powdered vitamin C you can find. Take enough until you
get very loose stools. By the way, it is a lot. On the day you do it, stay close to
home and fast from food all day. The next day go easy on introducing foods.
Stick with fruits and finely ground grains (nothing artificial and avoid dairy that
is not yogurt). Be careful with this one to not get dehydrated, ie. lots of water!
Another great cleanse is to eat only ripe banana (little brown spots on the peel),
plain yogurt, English walnuts, and unprocessed whole grain bread. If you mix
the banana, yogurt and walnuts it is not bad. At night, psyllium husk in orange
juice or a cleansing tea. I do this for as many days as I can stand it (usually 3-4).
Then start introducing other foods slowly. During your allergy season try to
avoid dairy except for yogurt.
2. Use a Netti Pot or something similar. When there is a histamine reaction, the body produces mucous in the sinuses. This mucous then works like fly paper attracting pollen and other allergens. Cleaning out the mucous can make a huge difference. If you have ever had plain water squirted up your nose, you know how unpleasant it is. So please, do yourself a favor and use warm water with the little saline packet they sell. You can make your own mixture but it is a pain and your compliance will suffer. I recommend cleansing the sinuses at least twice a day during allergy season. If your allergies are under control, 3-6 times per week will help maintain.
3. Work on your neck and head. The sinuses drain into several networks of lymph nodes that run along the muscles of the neck. Lymph utilizes gravity and muscle contraction to move down and eventually back into the blood where it will be cleaned by the kidneys and liver. If neck muscles are tight it will block the flow of lymph and the sinuses will back up. Getting adjusted to allow the neck to function properly will cause the muscles of the neck to settle down and be loose. In addition, a good massage can do wonders for getting lymph to flow. Finally, I adjust the cranial bones. When the sinuses exert a pressure on the skull it changes the shape of you head. Moving the plates of your head will help create the right pressure to push the mucous and lymph to where it is supposed to be.

“Stand Up Straight!” Part II – The Neck and Shoulders

Some could argue that good posture of the neck and shoulders is vital to your health. I agree! Most of the processes of life are controlled by the brain. Information then travels down through the spinal cord or through the cranial nerves. Either way, to get to the body it has to go through the neck somewhere. If there is not an efficient path then communication suffers.

As discussed in Part I, the outer part of the ear should line up with the middle of the shoulder. This has become so rare these days that you almost never see it. If you do, often times the only reason it is lined up is because the shoulders sit forward as well. If you go deeper (like on an x-ray) you should see a nice arc with the vertebrae neatly stacked on top of each other. The arc allows for maximum tensile strength and appropriate loading of the discs, ligament and muscles.

The head weighs about as much as a bowling ball so, in order to support the head all day long the neck should be underneath it. Generally, for every degree the head goes forward of the neck, you add an additional 10% more force. This is based on the pull of gravity and angles etc. With the head carrying forward the mechanical advantage of having an arc and the lever the muscles use start to lose ground. Pretty soon ligaments get overstretched and muscles are working much harder. There is also added pressure to the front of the vertebrae and decreased pressure on the back which creates imbalance. Imbalance leads to altered function which leads to altered nervous system flow which leads not only to poor coordination but also improper communication and disease.

Additionally, as the neck goes so go the shoulders. Shoulder injuries are one of the most common injury complaints. With shoulders you already sacrifice stability for mobility so if they are resting at an even less stable location (ie. rounded forward) then wear and tear is bound to happen. Furthermore, slumped shoulders can affect lung capacity and function. The last time I checked, most of us were already bad at breathing properly and I am pretty sure that oxygen is important to the body.

So what to do? First things first, in order to effectively improve posture, you have make sure that all of the joints are moving properly and coordinated together. Adjustments are very effective for this

Second, you have to stabilize the shoulder blades. The best way to do this is to pull the blades down and back while gently lifting the chest. This will stimulate the usually dormant postural muscles of the neck and upper back and relax the muscle that are carrying most of the work but shouldn’t.

Third, getting back the curve in the neck is tricky but important. I use what is referred to as a traction wedge my office. It is not very comfortable but allowing the head to hang over and edge with a tension band is effective in reshaping the neck.

Obviously, this is a process. It is usually not that effective to just try and stand up straighter. Nevertheless, with effort, results can be visible in less than a few weeks and long lasting results in less than 3 months.

Stay tuned for Part III where we discuss posture of the low back!

What is Health?

What is health? I ask this question all the time both to others and to myself. When I remind myself of the answer on a daily basis, I have real purpose to my work.

The definition of health used to be the absence of disease. That is a pretty narrow definition and, to my way of thinking, isn’t really possible. I think everyone has something that causes dis-ease and therefore, by definition has a disease. For that reason I think we have evolved as a society into a broader more dynamic view of health.

Health can be good or bad. It is a spectrum, if you will. Everyone alive has health to some degree. It is kind of like the old saying “If I didn’t have bad luck, I would have no luck at all.” Some people have bad health and others have good health.

To me, good health means that all aspects of the body function as they should. This includes functioning with other parts of the body. Proper function and even synergy of the body relies on good communication. Good communication is in large part dependent on a properly functioning nervous system.

The nervous system consists of the brain, the spinal cord, the cranial nerves, the nerve roots, and all the nerves with their bundles that come off of the nerve roots. The most common area of the nervous system to have a problem is the nerve root.

When vertebra in the back is dysfunctional it irritates the nerve root which alters communication to the organs and other parts of the body that nerve root innervates and leads to disease. Chiropractic helps relieve the irritation of the nerve. Simple as that!