When the Adjustment is not Enough

The Abridged Rant

Summary

• Chiropractic is physical medicine aimed at restoring both limited and painful movement patterns
• Positional faults are responsible for both limited and painful movement patterns
• Positional faults are caused by one of the three things:

1. Tissue Extensibility Dysfunction (trigger points, tight muscles and fascia, ect)
2. Joint Mobility Dysfunction (problems occuring at or within the joint capsule)
3. Somatic or Motor Control Dysfunction (signals going to and from the brain)

• Typical healthcare practitioners only focus on local sites of pain and miss the source
• GCMC screens movement patterns globally, allowing us to find the source of the pain
• GCMC uses:

1. Graston Technique for Tissue Extensibility Dysfunction
2. Mulligan Mobilization for Joint Mobility Dysfunction
3. Reactive Neuromuscular Training for Somatic or Motor Control Dysfunction

The Full Story

Chiropractic and Faulty Movement

Most would agree that chiropractic in its most simple of forms is centered on the detection and correction of faulty movement. The chiropractic adjustment or manipulation is the profession's most common and most accepted treatment intervention, designed to correct faulty movement occurring at any joint surface in the spine or in the extremities. But why do some chiropractors utilize more than just the manipulation? We at GCMC have a wonderfully simple reason based on very complicated science as to why we have multiple tools in our toolbox and why we feel that sometimes the chiropractic adjustment is just not enough.

The Definition of Faulty Movement

Let us first start with our concept of manual medicine and what we mean by faulty movement. Movement occurs at a joint. We have different types of joints that provide for different types of movement that allow us to move freely through our world and perform all of our activities of daily living. But sometimes movements become painful and can become limited. When this happens, manual medicine steps in to help break the cycle of pain and restore proper range of movement to allow you to continue to enjoy the activities you were temporarily prevented from enjoying.

The Three Components of Movement

Movement at a joint requires for three components to be functioning properly: joint mobility dysfunction, tissue extensibility dysfunction and somatic or motor control dysfunction. Failure of any one of these three components will lead to decreased and possibly painful movement. Traditional chiropractic would refer to the decreased and painful movement as the subluxation. At GCMC we use the term positional fault to describe the improper and painful movement occurring at one or many joints in the body. Arguably we are saying the same thing but we feel that the term subluxation has been misused and abused by so many uneducated people inside and outside of the chiropractic profession that we would like to make a point of limiting the number of ways you can interpret our intentions.

Why the Chiropractic Adjustment Works

So if there are three components, why do so many chiropractors use the manipulation as their first choice? Whether by intention or luck, there are three good reasons why manipulation is an effective treatment for positional faults: pain relief from endorphin release, increased blood flow outside of and nutrients within the joint, and neuromuscular retraining for improved range of motion. These three benefits were all explored in the article titled the Neurophysiological Effects of Spinal Manipulation. In the most recent edition of the Journal of Manipulative and Physiological Therapeutics, Taylor and Murphy's award winning paper showed how spinal manipulation alone could improve motor function in humans. But sometimes the adjustment is just not enough. Sometimes it only temporarily corrects the faulty movement and sometimes it simply just does not help.

Why the Adjustment is Not Enough: a Story of Symptom vs Cause

The most obvious answer we have as to why the manipulation is not enough is that sometimes the patient's chief complaint, the most obviously limited and painful movement, is nothing but a secondary symptom. Much like a headache caused by tension from the stresses of your occupation, aches and pains can be the result of repetitive stresses and strains put on your body from the demands of your daily life. And unless the injury was caused by blunt trauma from an object impacting your body, many times your aches and pains began as small compensations starting at one part of your body that eventually injured an entirely different area of your body. For example, maybe your first problem was limited mobility at your right hip. Eventually your lumbar spine adapted to the limited rotational ability of your hip and as a result became hypermobile. The hypermobility of your lumbar spine led to poor spinal stabilization at your core, robbing you of the ability to effectively use your upper extremities to perform push and pull movements. Your poor core stability eventually leads to you straining your supraspinatus muscle and results painful and limited arm movements, difficulty sleeping throughout the night and many painful trigger points along the muscles surrounding your shoulder. So you go to a chiropractor and complain of pain in your right shoulder with lifting and pushing, as well as difficulty sleeping at night. If all your chiropractor does is spinal adjustments, he or she will adjust your thoracic spine to help the dynamic of shoulder movements occurring between the glenohumeral joint and the thoracic spine. Even if your chiropractor addresses the other joints of the shoulder girdle or even the strain in your supraspinatus muscle, this is nothing more than taking Advil to temporarily cure your tension headache that occurs every Monday as you try to catch up on all the work that accumulated during the weekend. You must address the hip mobility issue and you must address the poor core stability if you are ever going to truly stop the shoulder pain from reoccurring.

GCMC's Global Take on Health

Poor movement screening techniques is one reason why we at GCMC feel that the chiropractic manipulation is sometimes not enough. No matter how good you are at fixing something you must first know what to fix. Many healthcare practitioners are stuck thinking locally while GCMC takes a more global look at your body. This is why GCMC uses an innovative evidence-based screening technique to identify not just the pain but the true cause of the pain. Once we have identified your painful and limited movement patterns we use three specific treatment techniques as well as many other more common treatment tools to correct the three main causes of painful and limited movement: to joint mobility dysfunction we use Mulligan Mobilization Techniques; for tissue extensibility dysfunction we use Graston Technique; and finally, to correct somatic or motor control dysfunction we use Reactive Neuromuscular Training.

Day 1: Pillars for Preggos an Addendum to What You Should Expect While Expecting

Approximately one year ago my father and I attended the 2009 functional training symposium for the NSCA. What followed was nothing short of inspiration for the work done at GCMC. It is no secret that the tide of health care is shifting towards prevention. Gone are the days of sick care, the kind of circular passive care that keeps on going, and going, and going, until your benefits are exhausted for the calendar year. GCMC is about supporting active lifestyles. It's the kind of health care facility that wont tell you to stop living. Juan Carols Santana, the representative for the NSCA at the symposium, provided us all with the vernacular to translate our heavy medical jargon into real words and concepts that everyone could understand. Thus was the birth of "pillar training" at GCMC and specialty classes like Pillars for Preggos.

It is all well and good that we should know proper lifting techniques; however, recent studies indicate that teaching proper lifting techniques does not simply translate into a world free of back pain. While the study did not answer why teaching proper lifting techniques did not prevent low back pain I have a theory of why and how that answer can lead to a better method of preventing low back pain in pregnant women and women with small children.

The answer is one of efficacy versus effectiveness. What I mean is that in theory and in ideal conditions, proper lifting techniques should help to prevent low back pain. However, we live in a less than ideal world and in less than ideal conditions. So while there may be some efficacy in lifting techniques, the advice has little to no effectiveness in the real world. And this is not a new concept; athletes do not train solely in ideal conditions. The distance runner does not adhere to only short sprints, on sunny days, with zero humidity, at zero elevation, and then go run a full marathon in Denver, Colorado in November.

This principle means a few things to the expecting mother. You can expect changes in the core musculature supporting your low back. Patterns of weak and tight muscles that will predispose you to certain aches and pains. You can also expect balance changes to come as your pregnancy progresses. Core strengthening exercises like the pelvic tilt, dead-bug, quadraped, and plank can help to recondition your core, while balance training can help prevent falls. However, you can also expect that your baby, once delivered, will put you in all kinds of precarious lifting situations, ones that making proper lifting techniques impossible.

As Juan Carlos Santana said at the Functional Training Symposium, "try to explain to a mother how to use proper squatting and reaching techniques while bending over across the back seat of a car to place a small child into a car seat or to take one out of it." It just is not possible. This is why Pillars for Preggos has the potential to be a success and help many new mothers. Life is movement, and bodies that move well, live well. It is important that you train for life. Being a mother is a full time job, 25 years later my own mother reminds me of this fact every day. So why not train your core in the positions it will be exposed to? We are all athletes of sorts. Some by vocation, some by recreation and some of us are industrial athletes. Consider yourself a domestic athlete, possibly one with the most physical demands.

Pillar Training for Preggos will be held every Saturday at 1:00pm. We had our first class today and it was a success. The group was small but there was a lot of learning and training, even for me. Of all the things I had accounted for, after all the training in classes and on my own, the one thing I did not anticipate was nausea. Needless to say we now have that under control. Today, some expecting mothers took their first steps to putting their pregnancy on a strong foundation and GCMC took their first steps towards fine tuning their first specialty group program. For more information about pillar training click here and to schedule online for the next Pillars for Preggos class click here.