As with every new patient, the first thing I did is a consultation, where I talk with the patient and get an initial idea of what’s going on. (We never charge for this, by the way, even if you have the best insurance plan available) During this consultation, the patient related to me that he had been to a medical clinic where they did x-rays.  The x-rays showed “nothing,” (there’s a reason why nothing is in quotations — that discussion is destined to be the next blog) and the doctor wanted to do an MRI. If you don’t have insurance, an MRI of the lumbar spine is at least $1,000!

Obviously, my patient was concerned that I might want to send him for an MRI also.

After examining the patient, I found that his condition was significant, but definitely not so advanced that I would need an MRI scan to figure out what the problem was! I see cases just like his and much worse, as a matter of fact, and I can usually help them with out the aid of an EXPENSIVE MRI scan!!

Then I got to thinking . . . for the average patient in my office, the ENTIRE cost of their treatment plan is less expensive than one MRI scan!!  A few plans are more, but most are even LESS!!  And also, you must bear in mind that AN MRI DOES ABSOLUTELY NOTHING as far as getting you better.  It’s just a picture which, more times than not, doesn’t show what’s going on any better than my bare hands or a plain, old fashioned, cheap x-ray! I know that’s hard to believe, but recent studies show that MRI findings correlate directly with pain findings only 5 – 10% of the time!

Ok, occasionally I send someone for an MRI.  But truthfully, it’s very, very rare.  When I send a patient for an MRI, it means that  1) After the patient’s initial examination, I think they may have a condition that may require surgery or other medical intervention that is not provided in our clinic,  or 2) they are not responding to our treatment, and I’m truly worried that there is something potentially dangerous going on.  For those cases, I’m very thankful for MRI technology.

So, here’s the take-home message:  Most primary care providers aren’t that great at diagnosing and treating most spine and joint problems.  Don’t get me wrong, I love primary care providers.  I even married one!!  If you are a diabetic with a new burning sensation in your foot, or you have severe hypertension, PLEASE don’t call my office!  That’s not my area of expertise!  But, if your back or neck keeps bothering you, or you keep having headaches (most of those are related to the neck — I’ll tell you if they’re not) . . . CALL ME!!  Or, if you prefer, you can go to your PCP, PAY FOR AN MRI, try some pharmaceutical treatment which rarely works, and THEN call my office!!

While your primary care physician’s chief focus is on your biochemistry, your chiropractic physician’s primary focus is on your biomechanics, that is, your frame and movement.

Chiropractors work on your spine and joints.  Because the spine is made up of 24 separate bones with very intricate joints, it gets most of the attention in a chiropractic office.  Furthermore, the spinal column contains your spinal cord, which keeps your brain in constant contact with the rest of your body.  When the spinal joints fail to work properly, it can create a long list of problems.  The chiropractor also diagnoses and treats problems with the feet, ankles, knees, hips, shoulders, ribs, elbows, wrists, and fingers.

The chiropractor can detect deficiencies in the position and function of the spine and joints and make corrections to these movement patterns through a series of “adjustments.”

Some spine and joint problems require other interventions.  Your chiropractor will know exactly who to refer you to for the help you need, just as your primary care physician may refer you to a dermatologist for a suspicious-looking mold on your skin.

Think of the chiropractor as a PCP for your spine and joints!

My wife and I recently purchased a house here in East Nashville that needed some work.  We needed a new kitchen and we needed to update the entire main level of the house.  My first instinct was to do it all myself, because I’m a pretty smart dude and I can figure it out.  And I was right.  If I really set my mind to it, I could design and install a whole kitchen.  It would function well and probably even look decent.

After a month of pulling out old carpet, asbestos tile, and dilapidated kitchen cabinets, my wife and I made one of the best decisions we have ever made — let a pro design it, and let a pro build it.  It was actually a difficult decision.  Professionals are EXPENSIVE!!!   AND I’M SMART!!!  I CAN DO IT MYSELF!! (said the cheap-skate voices in my head).

Our designer interviewed us.  I, being the visionary, told her what “we” were thinking, and she went to work.  A few days later, she e-mailed me with these computerized drawings of our new kitchen.  It was unbelievable!  It was similar to what I had envisioned but so much better!  And the colors she picked out for the entire house are just incredible!!  I would have NEVER picked those colors or even known how to go about matching all these things based on how the light from a window hits a certain surface or how things look from certain vantage points where you can see several rooms at one time.

And we hired a contractor who unlike me, has built many kitchens.  When I embark on any d.i.y. project, I spend more time driving to Lowes and Home Depot than I do actually working on the project!  Well, my contractor knew exactly what to buy, and even carried all of the tools he needed WITH HIM (what a novel idea!).

So, I figure, it would take me at least a year to do what they accomplished in 3 months.  My wife and I would live in a house with an unfinished kitchen for  that long.  And then, It would look like a normal, boring kitchen.  And, the walls throughout the house would be boring.

BUT WE WOULD HAVE SAVED A LOT OF MONEY!!!  Probably not!  By the time I drove to Lowes and Home D about 5,000 times, ate out most of the time (no working kitchen), tore down and rebuilt things that didn’t fit . . . I’m sure we came out ahead financially.

So the question is, will I EVER pick out paint colors again?  NO WAY!!  Will I pay somebody handsome bucks to do it for me?  YOU BETCHA!!

My area of expertise is the musculoskeletal system (spine and joints).  So many people think that they can solve their own back problems.  Example:  “I don’t need no chiropractor, I can pop my own back.”  OK, there, Mr. Expert!  Why is your problem getting worse over time instead of better?  Why do you feel the need to “pop” your back 25 times per day? Another example:  “My back kills me, but it’s my mattress.”  Further questioning reveals that they have been through 4 mattresses, some of them costing upward of $2,000, in the last year.  OK, there, Mr. Expert!!  Why does your back still hurt!!  Maybe you should spend $10,000 on a mattress!  Certainly THAT would solve your problem!!  The truth is, an average treatment plan in our office NEVER crosses the $2,000 mark!  In fact, it’s usually much less than that. Furthermore, Mr. Expert, if you leave the problem alone long enough for it to become a crisis, will it be any “cheaper” to address it then?

I can usually tell you in just a few minutes what your musculoskeletal problem is.  I can usually help you with it.  I know pretty quickly if it’s something I can’t help and I know where to refer you if that’s the case.  I’ve worked on THOUSANDS of spines and joints!  How many have you worked on?

So, don’t be afraid to hire an expert.  There is a cost involved, but believe me, It’s worth it!!

Seven years.  That’s how long I lived with lower back pain.

It started my senior year of high school in weightlifting class.  I was a pretty small dude and I wanted to bulk up some.  I worked very hard in that class and did bulk up a little bit, at the expense of my back.

The pain was in the left side of my rear-end and radiated to the back part of my thigh, all the way to the knee.  Sitting was excruciating.  Bending was very limited.  Standing up after being seated was a 5-minute ordeal.  I was moving like an old man and I was only in my early 20’s!

I went to a walk-in medical clinic.  The doc prescribed a muscle relaxer.  It didn’t help.  I went back.  He prescribed a narcotic pain-killer and gave me a page of back stretches to do (which I found nearly impossible to perform).  The pain- killer made me feel great at least while I was on the painkiller.  Maybe a little too great.  I found myself well on my way to becoming a narcotic addict.  I went back to the doc and asked him if I should go to a chiropractor to which he responded “absolutely not!  Chiropractors paralyze people!”  I took the advice of this misinformed doctor and just lived in pain.

My first run-in with a chiropractor took place at church.  I had gone on a two-week tour of Israel and one of the other tourists was the wife of a chiropractor.  She became like a second-mom.  I started hanging out with this family after church and even went to their house for Easter dinner (in 2000).  It was on that day that Dr. Don noticed that I was walking with a limp.  He said “I bet you have pain in the left butt and it goes down the back of your thigh about to your knee. . .”  I was flat-out impressed that someone could figure that out just by seeing me walk.  He invited me to come “hang out” in his office and see what chiropractic was all about.

To my amazement, I didn’t see anybody get paralyzed!  I heard no screams.  In fact, people actually felt better immediately after treatment without being high on drugs!

I decided it was worth a try.  On my first visit as a chiropractic patient, I was so impressed with this doctor!  He did a series of orthopedic and neurological tests and a set of x-rays.  He showed me exactly what was wrong and told me what it would take to get me feeling better.

After two weeks of chiropractic treatment I was a new man!  I had nearly full, pain-free range of motion in my lower back.  He found some things in my neck that weren’t working quite right either and got that taken care of. (I just thought it was normal to have a very stiff neck and not be able to turn my head after sitting in the car for about 30 minutes)  I was sleeping better because I could turn in bed without pain.

This was also a point in my life where I really needed to make a career choice.  I was a psychology major in college and was pretty sure I didn’t want to be a psychologist.  I was interested in medicine, but not that impressed with how conventional medicine treated me and my condition.  The logical choice, then, was to become a chiropractor.  I finished up some pre-med requirements, and off to Logan University in St. Louis, where I graduated as a Doctor of Chiropractic just four years later!

I love doing what I do.  Now I can tell people where they hurt just by watching them walk.  Now I can alleviate most headache syndromes, help fathers and mothers regain their ability to lift their children into their arms again, get runners back in races, help students with tight necks and shoulders focus on their professors rather than on how to get comfortable . . .  I could go on and on about how I’ve been able to change so many lives.

So when it comes down to it, I’m glad I had those seven years of pain.  It was a great lesson.  It taught me to truly sympathize with my patients.  When I realized how quickly my problem could be alleviated, I was introduced to an excellent career!

The last 10-12 years have seen many changes in this line of thinking.  Hundreds of RCTs have been carried out offering volumes of information on the efficacy of spinal manipulation (the main treatment used by most chiropractors) on the treatment of a myriad of health problems.  We now have hard scientific evidence that chiropractic treatment is great for some things, good for some things when combined with other therapies, inconclusive for some things,  ineffective for some things, and makes some things worse — just like pharmacotherapy and surgery.  We also have hard evidence that chiropractic treatment is superior to pharmacotherapy, surgery, and non-manipulative physical therapy for several conditions.

A brand-new literature review by Bronfort, et. al compiles and summarizes ten years worth of research on the efficacy of manual therapies.  Manual therapies include chiropractic and osteopathic manipulation, physical therapy, and massage therapy.  Here’s a link to the study:  www.chiroandosteo.com/content/18/1/3

Here is the conclusion paragraph of the abstract:

Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation. (Bronfort et al. Chiropractic and Osteopathy 2010, 18:3)

This is well said and very clear.  It seems to be consistent with my own experiences in practice.  I am pleased to have such a well-written review with a bibliography of over 300 peer-reviewed journal articles to refer to.  I encourage all who are interested to follow this link and read the article for themselves.

Before I go on, I must address an unfortunate issue.  There are some BAD chiropractors out there. I cannot deny that we have more than our fair share of bad apples in our profession.  There ARE chiropractors who will keep you coming in much more than necessary.  I had a patient come to me from another chiropractor who had coerced her into paying for 80 visits UP FRONT! (I’m glad she had the wisdom to ask for a second opinion, and so is she!). There are very few patients who need that many treatments in a year’s time.  In fact, in most cases, this many adjustments would do more harm than good.  If you feel that your chiropractor is ripping you off, GET A SECOND OPINION from a DIFFERENT chiropractor.

Typically, chiropractic care involves a treatment plan made up of multiple sessions.  This is no different from physical therapy, speech therapy, orthodontics, among others.  Most drug-based therapies require that you swallow chemicals every day for weeks to years.  In fact, there are very few “quick fixes.”

The human body is very complex and is very resistant to change.  What I do is recondition the way the spine and other joints move.  It involves changing the NEUROLOGICAL PROGRAMMING that controls movement. This is much more involved than finding a bone that is “out of alignment” and “popping” it back in place. It just doesn’t work that way.

So here is how I respond to those who are surprised or upset that chiropractic care usually involves multiple treatments:

If I could fix your problem in one visit, I would. If I came up with a way to restore optimum function to the spine, and eliminate back pain in one visit, people would be lined up out my door, around the block, and probably all the way to Kentucky to be treated by me.  People would gladly pay $5,000 or more for me to “fix” them, it wouldn’t even matter if I was in their insurance network or not.  My treatment room would be full of other doctors learning to do what I do.  I would stay in private practice for a few years and become a wealthy, wealthy man.  I would then buy a jet and travel the world, providing my services for no charge to anybody who needed my help.

Unfortunately, it doesn’t work that way.  Our fee schedules are built to accommodate multiple treatments.  In our office a treatment session costs between $45 and $100 (depending on what we do on that visit).  The average out-of-pocket amount for uninsured patients is around $50 and $25 for insured patients.  Treatment plans range from 6 to 40 visits over a 2-week to 4-month period.  The average treatment plan is around 18 visits over two months time.  You can do the math.

The good news is that I CAN very likely help you.  The effectiveness of chiropractic care is head and shoulders above other treatments for most cases of back/neck pain.  The MEDICAL literature (not just chiropractic literature) has hundreds of studies proving this (a future blog will be a bibliography of medical journal articles that clinically back-up what I do).  The cost of what I do ends up, in most cases, being LESS than the other treatments.

In short, I will do the best I can to get you well and keep you well in the least amount of time possible, at the least possible cost.  IN MOST CASES (I’m not God.  Pretty far from it, in fact) you experience great results and refer all of your friends who may need my help.  THAT will ensure my financial success (I do want to be financially successful, don’t get me wrong). THAT will also ensure that I get to help lots of people, which is more rewarding than the money!

Another reason I like going to this store is I like watching the “hippies” who shop there.  I’m talking real hippies, here.  Just wearing tie dyed clothes, long hair and sunglasses doesn’t cut it.  Real hippies try in every way to buck the system of Capitalism.  One major aspect of the Capitalist society is corporate agriculture.  Mass-produced, high fat, salty, overprocessed, genetically altered foods are a large part of corporate agriculture because these foods are easy to produce and have a long shelf life.

The “real” Hippies just don’t go for this.  For the most part, their diet consists of food grown locally on small farms.  Food grown locally on small farms is not cheap.  And last time I checked, very few Hippies are rich.  If nothing else, the cost factor limits how much they eat.  Plus, local small farms don’t produce trans-fats (that involves a chemistry lab), overly fatty meats,  and preservative-loaded sweets full of high-fructose corn syrup.  Therefore, there is a huge lack of OBESE HIPPIES!!

I’m not totally against corporate agriculture.  I’m not an anti-capitalist.  I am a proponent of full disclosure of the ingredients of the foods we eat.  I am a proponent of doing real research on these ingredients and finding out the health risks/benefits of them.  I am a huge proponent of using common sense with food!!  Eat some veggies!! If it’s full of chemicals, you probably shouldn’t eat it!!  Consume only the amount of energy (food) that you will use.  If you sit at a computer all day, you probably don’t need four pounds of food per day to meet your metabolic needs.

Enjoy a Snickers bar sometimes.  Drink a Coke with it.  For the most part, however just eat some lentils and hummus!

Let me explain this for those of you who aren’t intimately familiar with chiropractic.  Some chiropractic colleges teach mostly “chiropractic philosophy,” and teach as little as possible about the human body, disease, and such.  They don’t like research because that is too much like the “medical model” of health care.  They don’t want to know how to do a full physical exam on a patient, because they don’t diagnose “medical problems,”  they only diagnose “vertebral subluxations.”  They don’t “treat back pain,” they only adjust the spine, and so on.

Well, the truth is this.  Most people who go to a chiropractor have some kind of back pain.  And guess what . . . there are MANY different causes of back pain, not just vertebral subluxations.

This week, a patient that I hadn’t seen in awhile came in with a new complaint.  She had severe pain in her neck and right arm.  I examined her.  When I examine a patient, I do neurological, orthopedic, and chiropractic testing.  With this patient, I didn’t even get to the chiropractic component of the exam because my neurological tests told me that this patient was dealing with something that I do not treat in my office, and that’s metastatic lung cancer.  She had no reflexes in the right upper limb.  Skin sensation was decreased in some parts of the limb, and increased in other parts.  The slightest pressure placed on the lower neck was very painful.  She was holding her right arm against her chest with her left arm because it was very weak.  Her health history revealed a 40+ year history of smoking at least a pack per day.

Almost immediately, I could hear Dr. Kettner, Dr. Geubert, Dr. Kuhn, Dr. Bub, Dr. Huber, Dr. Mannello, and others . . . their voices are permanently lodged in my head, reminding me of things to look for, what certain symptoms and signs might point to, other tests that may be applicable in helping to DIAGNOSE THE LESION!!  This time I remembered Dr. Kettner and Dr. Geubert talking ad nauseum about Pancoast Syndrome, which is related to a metastatic tumor in the upper part of a lung.  That was my diagnosis, and I sent her to the ER for immediate CT scans and bone scan.  Sure enough, that was the correct diagnosis, (unfortunately, in this case).  In fact, the ER doctor called me — she was impressed that I could diagnose that without ANY imaging, just history and physical exam.  The patient called me from her hospital room a day later and thanked me for catching the tumor and sending her to the ER, because it gives her a chance to “get things in order”  (unfortunately, the cancer had spread throughout her body, and she will probably not be with us for much longer).

So, Logan is a GREAT school.  They teach you all of the things you NEED TO KNOW so that your diagnostic skills will be on par with (and sometimes better than) the practitioners in main-stream medicine.  Chiropractic philosophy is important too, but a DOCTOR of chiropractic has the responsibility of knowing when the problem is NOT just another vertebral subluxation.

So here’s a possiblilty.  We were born to walk barefooted on the soil, and we almost never do that. Think about it.  Why do we have flexible feet and controllable toes?  If we were made to be on concrete all day, shouldn’t we have wheels instead of feet?

When we walk on a soft surface such as a grassy field or a sandy beach, two things happen.  1)  We leave a footprint, and 2)  Our bodies have to use their sense of balance to keep us from falling over.

We leave a footprint.  Footprints are evidence of a compliant surface, meaning that surface absorbs shock or impact as the force of our bodies lands on that surface.  Every time we take a step, the force of that motion must be dissipated, or cushioned somehow.  On a softer surface, a great deal of the force is dissipated externally, or outside the body.  Blades of grass bend or break.  Grains of sand separate.  A slight indention is left in the surface.  On a non-compliant surface, however, nothing changes.  Concrete granules do not move farther apart.  No indention is apparent.  The question is, then, “where does the impact go?”  The answer would be YOU.  That’s where the impact goes.  The ligaments and joint cartilages absorb most of that extra impact — which is exactly what they were meant to do.  However, they were meant to have some help from the ground we walk on.  All of this extra stress leads to tears in the fibers of these connective tissues. (references to come)  Years of the abnormally high impact can lead to a high volume of these “micro-tears” which can have a negative impact on the integrity of the tissue, and thus lack of joint stability and strength.

On a softer surface, our bodies have to work harder to stay balanced.  This is where a good dose of neurology is appropriate.  It take quite a network of nerves and brain-firing patterns to keep us upright.  Compare it to chewing food.  How do you know when it’s safe to bite down without biting off your tongue?  There are thousands of nerve endings in your tongue, called proprioceptors, that alert your brain as to the exact location of your tongue.  The signals are processed in the brain, creating the proper motor signals to bite down and move your tongue out of the way at the same time.

We stay upright by a similar process.  The muscles of our back, particularly the deepest layers of muscle that are fitted snugly against the spinal column, are heavily embedded with these proprioceptors.  When we move, constant signals are generated by these nerve receptors and sent through the spinal cord to the brain.  This way, your brain has a good “picture” of the exact location of your back based on the length of certain muscles and minute changes in the length of these muscles.  These signals are processed by several areas of the brain and spinal cord to produce motor messages from the brain that coordinate the motions of the larger muscles that control gross movement of the spine (and other joints).

When we are on extremely stable surfaces, such as concrete and most flooring, that system no longer has to work very hard.  As we all know, “if you don’t use it, you lose it.”  The small, unexercised proprioceptive muscles in the deep back lose their tone.  As a result, we lose CORE STABILITY. [ "Core" is such a buzzword and quite misused these days.  That is for another blog.  Stay tuned.]  We are essentially left with weak & injured, lazy backs that have lost their ability to move correctly.  There are even professional athletes with weak, lazy backs –they just don’t know it.  Yet.

So how does a chiropractor “fix” this?  These poor motion patterns cause certain segments of the spine to either “lock up” or move abnormally.  A good chiropractor will pick out these joints, and through a series of “adjustments,” re-establish proper motion into these joints.  (Beware of the chiropractor who just “pops” every bone in your spine.  It feels good for a few minutes, but you certainly don’t want to introduce too much motion into joints that don’t need it).  Once we start to get the dysfunctional joint moving again, we have a series of exercises to help build the “core strength” of that joint (Core strength training does not mean doing 4000 crunches, by the way).  It involves mostly some stretching and balancing techniques that we teach you in our office and encourage you to continue doing them at home or at work.  In my practice, we refer to this process as Spinal Reconditioning.

Alternatively, you should pack up (and get rid of) 96% of your “stuff” and move to a quiet sandy beach somewhere and live barefooted.  Keep a garden to grow your own food, plus the exercise of bending down (a heavy-user of core strentgth) to pluck weeds.  Probably not much need for a chiropractor in that environment.

I get so many different reactions when I tell people I’m a chiropractor.  Some say “I love my chiropractor blah blah . . . , Some look at me like I have an extra arm growing out of the side of my head.  Some ask for my business card and become patients.  But many explain their neck/back/joint problem to me in great detail then tell me the “reason” they are in this condition, and how it’s NOT a problem that requires the attention of a chiropractor.  I’ve found that most of these people really, REALLY need chiropractic intervention!!  So, here are a couple common excuses I hear and my answer to them.

EXCUSE:  I don’t need a chiropractor, I just have some tight muscles.

EXCUSE BUSTED:  This is a phrase I hear quite frequently.  The second part of the phrase is typically true.  People with spine problems typically have tight muscles.  Muscle tension is rarely a sign of a muscle problem.  It is usually a sign of spinal dysfunction, meaning the bones, muscles, ligaments, and nerves of the spine are not working together the way they should.  Chiropractors are very good at getting the spine to function as it should.

EXCUSE:    “Yeah, my back is killing me, but I’m pretty sure it’s my mattress.”

EXCUSE BUSTED: A truly horrible mattress can certainly hurt your back, but we’re talking about a really, really bad mattress that sags horribly, or that is so “firm” that it’s like sleeping on a concrete floor.  Nevertheless, if you injured your back on your mattress, you probably have some dysfunction in your spine that needs to be addressed.

EXCUSE: “My neck hurts and I have a headache everyday, but it’s just stress. I don’t have a spine problem and I don’t need a chiropractor, thank you very much”!!!!

EXCUSE BUSTED:  A dysfunctional spine usually raises the resting tone of the spinal musculature in that area.  In other words, if your spinal bones do not move properly, it  brings that area in your spine closer to the “pain threshold.”  At this point, it only takes one bad phone call or one snide remark from your teenager to put your neck into total spasm.  This, in turn, makes you more sensitive to other snide remarks, and so the vicious cycle goes. 

By re-conditioning your spine, we can lower the resting tone of your spinal musculature.  A dumb remark from your boss or a smart-alec eye-roll from your teenager may cause a little twitch in your neck muscles, but not throw them into complete spasm.  Give it a try!  It really works!!