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.

Arthritis Foundation's 2009 Women's Health Summit

I wanted to take a moment write about a first time experience I had on multiple levels. My father, Matt and myself were recently asked to give a presentation on the importance of exercise with arthritis for the Arthritis Foundation's 2009 Women's Health Summit. There were multiple speakers in different rooms with various background ranging from the Chief of Geriatrics at a nationally ranked hospital to the nutritional advice presented by an RD.

As I mentioned, this was my first of many: this was my first public presentation for GCMC, this was my first time speaking in front of an elderly population, this was my first time working with the Arthritis foundation, this was my first time presenting along side MD's and DO's, and this was my first time bring our message of "Life is Movement" to a larger, non-athletic audience. And for all of those reasons I was slightly nervous. We have conveyed our ideas to many types of athletes with great reception; however, I have never tried to communicate our message to those indifferent to exercise.

I thought that my biggest problem would be my message being lost in translation to an indifferent crowd, but the real challenge wound up being much more primitive. When given the choice of which presentation to attend, the vast majority was more interested in attending a lecture on which medication they could use to manage the pain then to listen to about how maintaining a quality of life is two-sided contract. As health professionals at a movement center, our end of the contract is to get them moving again and their end is to actually take responsibility for their health and not to accept a defeatist mentality. What I found was that people are much more inclined to wave the white flag then to fight for their quality of life.

It is sort of ironic in a way, I did include in my presentation how nearly a third of those with arthritis live completely sedentary lives. I knew that the problem was a misconception that movement was the problem and that exercise would only hurt them, when in fact even Harvard has recently published that one to two hours of moderate exercise can prevent pain from osteoarthritis all together.

So I guess that my point is we have more of an up hill battle than I expected. The good news is that those that chose to listen to our presentation were very receptive to our concepts. They very much understood what I said and felt that we understood their battles. Now what is left is for us to really push the concept of exercising to reduce or eliminate pain. We have lived in a sick care nation for a very long time. We have conditioned the aging population to accept defeat: loss of hearing, loss of memory, loss of vision, loss of balance, loss of strength, loss of driving, ect. It is time to take the focus away from pain and towards performance.

At GCMC we acknowledge that everyone has a goal and desired level of performance. That can mean you want to run an ultra-marathon or that could mean you want to walk pain-free around the mall. The point is we are all training for something and that, at the very least, we are training for life.

The Exercise Experience in Adults with Arthritis

This October 3rd I will be representing GCMC, along with my father and Matt, at the Women's Health Summit for the Arthritis Foundation. The topic we will be presenting is the importance of exercise with Arthritis. It almost would seem counter-intuitive that someone with a degenerative or inflamed joint should be moving that joint freely, but it is in fact true. And not just true, but imperative. The subject touched me and I feel it is important to help shed light on the facts.

Studies have shown that despite the importance of exercise, 31% of those with arthritis live completely sedentary lives. Those that were athletic before the arthritis tend to remain active after the diagnoses. They seem to have better handle on how to exercise and how to modify an exercise due to pain. However, those that were not athletic to begin with tend to be fearful of exercise, especially if they attempt exercise and experience an copeless amount of pain.

There are over 100 types of arthritis, the most common being osteoarthritis followed by rheumatoid arthritis. Osteoarthritis (OA)is the leading cause of disability, affecting more than 22 million adults in the United States. There is no cure; however, there is a lot you can do to slow down the progression and manage the pain. I have a busy class and work schedule, so in the interest of time I will list the evidence supporting exercise and provide a link to the Arthritis Foundation for further information on how to be healthy with arthritis. Besides, the journals could not be any more to the point.

Harvard's Women's Health Watch stated that regular exercise strengthens muscles and improves flexibility and balance. It not only eases pain and stiffness but improves overall health. New research suggests that older women may be able to prevent OA pain by getting as little as one to two hours of moderately intense exercise per week.

The American Journal of Health and Behavior stated that, "regular exercise by people with arthritis delays disability; improves physical function; improves quality of life, mental health, aerobic capacity and muscle strength; promotes functional independence; and reduces pain." (Am J Health Behav. 2006;30(6):731-744)


The Journal of Rheumatology printed, "it is now established that well-designed physical exercise programs promote prolonged improvements without inducing harmful effects on disease activity and joint damage” Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review." (Rheumatology 2008;47:239-248)

Archives of Internal Medicine stated that, “Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee OA. Our study suggests that a physical exercise program may be an effective strategy for increasing the active life expectancy of older adults.”(Arch Intern Med. 2001 (161). 2309-2316)

Link for Arthritis Foundation