If I could, I would . . .
Many patients are surprised at the fact that it typically takes a series of treatments to get the results we are after. Other potential patients never come in for the help they need because they’ve heard that “once you start going to a chiropractor, they just make you keep coming in every other day for the rest of your life,” or “I don’t go to a chiropractor because I don’t want to get addicted” (as if we are piping crack smoke into the treatment room). So this is the subject I want to tackle in this blog.
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!
Where are the Obese Hippies?
There is a health food store here in Nashville that I like to go to. They sell some pretty “normal” things like organic meat and veggies and such. They also sell all of the hard-core health foods like tofu, alfalfa sprouts, whole grains in bulk, every bean you can imagine. This is what some of my patients refer to as “hippie food.”
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!
Why Logan College of Chiropractic is a GREAT School
I had a patient come in for an evaluation. She was dissatisfied with her current chiropractor, who persuaded her to pay close to $3000 up front for 80 visits, “a year’s worth” of treatment in his office. (That will be discussed in a whole new blog — entitled “Why most people think Chiropractors are Quacks”) As I was examining her, she asked where I went to Chiropractic College, and I replied “Logan, in St. Louis.” She then told me that the other doctor told her that he went to Logan, but it’s a terrible school because it’s “too medical.”
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.
Why does my back hurt? We’re vicims of our own luxury. That’s why!
The most common question i get in my practice is “WHY”? “Why do I get headaches”? “Why does my back hurt when I get up in the morning?” “My fingers are numb. Why?” I do my best to explain biomechanically and chemically what’s going on, but that rarely answers the question “Why?” The exception, of course, being direct trauma — i.e. ” Your back hurts because you fell off a ladder onto your back and injured the tissues of your back.” The causes of most back problems, however, are not so simple to explain. You can have back pain, headaches, morning stiffness, etc., etc., even though you’ve never fallen out of a tree or been in an auto accident. Then the logical mind will just assume that it’s “genetic.” Plenty of people are satisfied thinking that they have “bad genes” and there’s nothing they can do about it, so might as well just stay high on narcotic pain killers and avoid exercise at any cost. Some people are just not satisfied with that verdict and sentence. (Not to diminish the importance of genetics, but genetics are only PARTLY responsible for the fate of your musculoskeletal system).
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.
Excuse Busters, Part I
Excuse Busters Part 1
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!!
