RochesterChiros Blog

As an alternative health care provider, sometimes I can’t help but feel like people continue to overlook us until they really want us.

Not an uncommon experience.

Back pain has been the proverbial “thorn in the side” of the modern healthcare system.  The majority of the population experiences it, finding an effective treatment can provide a monstrous challenge for allopathic medicine, and lastly it is a COSTLY problem (estimates start at 10 BILLION.)  How this problem is managed has always presented a challenge for the American health care system.

Before I go off on too many tangents, the reason I bring this up is because the Journal of the American Medical Association (JAMA) recently published an article providing an overview of mechanical low back pain.  The article discussed the problem of back pain including what causes it, but it also promoted the use of conservative treatment for back pain.  Conservative management including chiropractic care!

Now for most people that article may not sound surprising, but many of you may not realize that chiropractors and the American Medical Association haven’t always gotten along. Their relationship started off with a lot of bickering and name calling, and decades later could still only be described as tenuous.

                          No one captures “tenuous” like Bill Watterson.

Over the last few years there has been a lot of improvement, but that underlying tension has stuck around and we generally were not the people your doctor would refer to. So you could imagine our excitement at the notion of being RECOMMENDED as a first step with the treatment of back pain!

Chiropractors (as well as their patients) have known for a long time that we are the go-to doctors for mechanical back pain. The problem has always been that without endorsement from primary care physicians and medical doctors, chiropractors have been considered a last resort when all else fails.  Admittedly, many of us have always experienced a sense of pride with providing someone the secret to fixing their pain after everything else had failed; but just as many of us have wished we could have seen them sooner.  Well, this new acceptance and recommendation could perhaps create that change we’ve been looking for!

The message is simple, back pain is a common problem that usually takes cooperation between many different doctors to correct.  We are glad to finally be part of that schematic in the eyes of fellow health care providers.  Chiropractors are the non-surgical specialists of the musculoskeletal system, and finally we are being seen as such by our colleagues in healthcare.  If you are dealing with back pain there are many places to start, but we are always happy to help you.  –Dr. D

I recently had a new patient encounter that went something like this…

Stressed and in pain patient (SAIPP): “Dr. Daly, I think spinal decompression would be very helpful for my pain but I cannot afford the $3,000 down payment. “

Me: “The WHAT?!?!”

SAIPP: “Well I went to another Chiropractor and they told me they would be happy to help me, but that I needed to sign a contract for treatment and pay up front”

Me:

The face is slightly exaggerated (my eyes aren’t blue), but It’s hard for me to come up with any other initial response.  And seriously, I’ve had A LOT of opportunities to work on it.

The story seems to repeat regularly.  People will hear about a new and exciting therapy for their pain, often including one of the following; chiropractic manipulation, spinal decompression therapy, low level/cold laser, soft tissue mobilization/treatment, traction, etc. The advertisements sound promising, and after they visit the advertising office they find out the treatment costs $3,000 and requires a three time a week treatment plan for 6 months.  They will assume that the $3,000 one-time payment is needed for the treatment, and will go ahead with the expense in hopes of relief.  Many of them are unfamiliar with chiropractic and assume that all chiropractors require the same investment.  Not knowing their options, the SAIPP (read above) will end up buying into an expensive plan that is not covered by their health insurance.  I’ve heard this frequently and I’ve tried to shrug it off, but it is getting ridiculous.

Patients of the world:  do not be swindled.  Spinal decompression, spinal manipulation, cold laser, soft tissue work, and just about everything else doesn’t require months of mandatory treatment and certainly DOES NOT require prepayment!  Our office, (along with many other ethical offices) offer the above treatments as needed or as part of a treatment plan at the standard office fee which is covered by most insurance plans (40-50$ per visit around here).  Why?  Because we do not need to guarantee your return! If we are careful with our diagnosis and utilize the appropriate treatment you should want to come back.  If you were unhappy and didn’t like chiropractic treatment; I’m sorry I couldn’t help you, and I will be happy to refer you to someone who might be able to. There’s no paying in advance for treatment here.

Unfortunately patients who have been duped by his business strategy often have a jaded view of chiropractors, and with good reason. They also have a significant bill that their insurance didn’t pay for, and if the treatment wasn’t helpful they could still be struggling with chronic pain.  After finding out they can receive the same treatment for much less, patients are usually a frustrated combination of happy and angry: “hangry”.  Most people aren’t too happy to pad someone else’s wallet with their own money.

            Prepayment is a great way to make a buck.  You advertise extensively, make sure patients are desperate and come to you in pain, and corner them into an expensive treatment plan.  It walks the borderline of ethics, but is an ingenious way to make money.  People who are scared and in pain are often willing to spend money for anything that will help!  I’m just not certain who this treatment is benefiting… it doesn’t seem too patient centered to me.

I love what I do. I offer a specialization in healthcare that is sorely needed.  People are often amazed to hear that their back, ankle, elbow, or neck pain can be treated easily without medication or surgery.  But I do not like how some of my colleagues operate. So stop.  Seriously, it makes us all look bad.  If you are in pain and think a chiropractor can help, do some shopping.  You should never be forced to pay absurd amounts of money or get involved with ludicrous treatment plans to find relief.  There are many of us out there who are looking out for our patients, not for our wallets. – Dr. D

I’ve heard this story a lot, especially lately.  I figure it’s a significant enough situation that something needs to be said about it. Let me know if this story rings a bell…

“Dr. Daly, I have a friend who cracks people’s backs for free. Isn’t that the same thing you do? If that works why should I see a Chiropractor?

Sound familiar? If not a question you’ve said aloud, I’m certain you’ve either thought it or had someone ask it in regards to Chiropractors.  In retrospect my biggest mistake was not getting anything signed to get that nickel for every time I have heard it… I need better legal representation…

Good question though right? It doesn’t matter who gets your bone to crack as long as it cracks! What’s the difference?!

Well, some might claim it doesn’t matter.  I however have to play the devil’s advocate and say it matters very much.  As I often do, I will elaborate.

So let’s wrestle this, what’s the big deal with people “cracking” one another’s backs.  I can vividly remember people in middle school, high school, and later college who would boast this ability. They would offer to crack your back, and would do so without any pre-requisite qualifications other than success after a few drinks.  So let’s start this simply; the spine is complicated.

There are numerous moving parts, hundreds of muscles, and let’s not forget the spinal cord with its 62 separate spinal nerves.  Chiropractors have spent over 100 years studying just the spine and how it operates. Chiropractors- Both through history and today have spent their years developing techniques to manipulate the spine (cracking).   We know how to manipulate joints with the appropriate amount of force and in the right direction to both create change and avoid side effects.

Without training and education, there are many possible side effects to trying to manipulate the spine. A short list includes broken ribs, sprains/strains, and without a proper examination any number of more serious side effects- incontinence, paralysis, perhaps even strokes! Non-specific and often aggressive attempts to manipulate the spine may get the crack, but are hardly without risk.  Again, not to toot our own horns, but Chiropractors are doctors who specialize in the treatment of the spine. We know how to examine it for conditions and disease, we know how and when to treat, and most importantly we know when NOT to adjust.

All side effects and nuance aside, the most important issue I have with the good ol’ back crack, is that it is practicing without a license.  “So what? It’s not hurting anyone?” Wrong, first of all it is a criminal offense and a felony in most jurisdictions. Second, going blindly into anything that you have no understanding/experience with is always a bad move. Having the tools for the job isn’t the same as knowing how to do the job.  Adjusting the spine may seem easy- odds are you have a spine, and most people have a hand or two, so it seems pretty straightforward. But If I received a bullet wound (yikes, what was I doing?!), I would prefer to be treated by a trained trauma surgeon over someone on the street with a knife and a set of needle-nose pliers!

So let’s discuss the real world example of what can happen when we do this. So we’ll pretend you offer to crack your friend’s back. He’s been having a rough week and you don’t think he should have to pay for what you can do right at home. You tell him to lie down and you proceed to walk on his back to get it to crack.  Now, Let’s also pretend you don’t exactly have a thorough understanding of the spine and your foot slips and you break a rib. Your friend gets mad about the broken rib (which are generally pretty uncomfortable) and does a not-so-friendly thing and sues you.  You have no license, so right from the start you have have zero defense for what you were doing. Next you have no malpractice/ liability insurance, so whatever he sues you for you will be paying for out of pocket. Suddenly the harmless crack you did ends up being a $200,000 oopsie with a chance for jail time.

            This whole post might sound like a ruthless exaggeration, but I would caution you to talk to a Chiropractor first. We spend a significant amount of time in school learning the ins and outs of working with the spine. We know the good, the bad, and the ugly. Nothing is worse than the “adjustments” performed from first year Chiropractors (not picking on anyone, I was there once).  Limited skill and limited knowledge in anything is going to be trouble, but with regards to healthcare and Chiropractic specifically is often painful. We pay for malpractice because even the best Chiropractor, on his best day, isn’t without the possibility for risk.

I swear I’m not just writing this from a soap box to try to sound better or more capable than anyone else. The point of writing this is to bring home an important point- it’s dangerous to practice without a license.  If you think someone need’s a back adjustment either take them to someone licensed to treat the spine, or tell them to wait a few years for you to get the appropriate education and license to do so.  Questions? Comments? I’d be happy to talk- Dr. D.

No! Not my ears!

“Ear infection? Try treating it with droplets of breast milk placed directly into your child’s ear!”

…  and there you have it….After much deliberation on what witty and clever method I would use to start this post, I realized there was no other way than to just throw it at you.

Dr. Kinsler and Myself came upon that “fascinating” new treatment a few weeks back and it hit us about that hard.  Those of you with an inquisitive rational mind are probably thinking- “uh what? Where on earth did you hear that, and who would say that?”  Trust me when I tell you, those were the exact questions that I had.  I subsequently went on a research journey to figure out where putting breast milk in your child’s ear came from, and if there was any validity to it.

First, as most informed health providers often do, I perused the scientific literature on the topic.  Peer reviewed studies provide the ground work for evidenced based care, and allow us to figure out whether or not a given treatment is useful.  Sadly, this first step proved to be a roadblock.  There is nothing. Again, nothing.  Without evidence this claim exists solely through anecdotes. And anecdotes are just that- individual stories lacking real evidence.  In healthcare stories should not be confused with legitimate and valid science.

So the first and arguably most important aspect of my journey had hit a wall. There was no scientific evidence, but what about the science behind this claim? Surely there is a valid reason it exists! Well… I’m not sure about the “Science” to this one…This mystical home remedy seems to persist through various message boards and online discussions, so I will address some of the claims seen most often.

1^st, Breast milk is full of antibodies and can assist in fighting the infection.

That is true breast milk IS full of antibodies, at least for about a week.  Colostrum is the earliest form of breast milk, which sticks around for the first 2-3 days after birth and is loaded with antibodies.  Transitional milk is the next in line and lasts for about a week,  but by day 10 breast milk composition is mostly water and fat (with some extra micronutrients and vitamins)[1].  So if you were to tell me your 3 day old baby acquired an ear infection and that you dropped your Colostrum directly into the ear canal for the purpose of bringing in antibodies: I would tell you that you are at least making an educated attempt. But if you are using fresh breast milk for your 6 month to 2 year old infant (most common age group to get ear infections), you sure aren’t doing it because of antibodies.

2^nd, Breast milk is naturally antibacterial so drops into the ear will treat the infection.

 If we look at the ear itself, most ear infections (Otitis Media) occur in the middle ear. The middle ear is the area behind the ear drum (tympanic membrane) which transmits sound to the inner ear. The tympanic membrane is impenetrable to fluid, which is why many complicated ear infections require surgical tubes in order to drain the ear of fluid.

Now if we know that the eardrum is impenetrable to fluid, one would have to wonder how or why someone would use ear drops to treat a middle ear infection.  Assuming that the ear infection is indeed bacterial (most aren’t) and that a few drops of breast milk would be enough to have an effect on a bacterial infection (it’s not), there is no way that the breast milk would be able to penetrate the ear drum.

I promise I am not trying to pick on breast milk.  As far as NUTRITION for infants goes, there is nothing better! (you will notice “Nutrition” is capitalized)  And there is in fact an association between breast milk and ear infections… Children who are FED breast milk demonstrate a significant resistance to acquiring ear infections as infants![2] (again, notice “fed” is capitalized).  The added benefits of breast milk could stretch for miles, but they surround feeding with it not dropping it haphazardly. My point is simply that just because something is very effective in your mouth does not mean that it will be effective wherever else you put it!

In order for a treatment to be useful, it should either have physiological logic behind it or evidence to back it up or even better have both- this one has neither.  So would I recommend a new mother put her breast milk into her sick child’s ear? The answer is a resounding no.  Now incase anyone is dealing with a Child who suffers from regular ear infections, here are a few links describing the current treatment guidelines for Otitis Media that you can discuss with your pediatrician.

http://www.sciencebasedmedicine.org/index.php/ear-infections-to-treat-or-not-to-treat/

http://pediatrics.aappublications.org/content/113/5/1451.full#sec-11

Lastly, I want to reiterate; at this point there is no research to back up this claim but if someone should decide to research the topic, we will be sure to keep you all abreast of the situation. -Dr.D

‘Tis the season for family, fun, and sweets! With that, during this season every year the United States goes through over 2 BILLION candy canes[1]!  I know what you’re thinking- that’s A LOT of candy.  It sure is, it adds up to almost 20 billion grams of sugar. While this obviously presents a dental dilemma, Candy canes (Peppermint specifically) may have another side effect: keeping you up at night.

Peppermint while being tasty has an unfortunate side effect of relaxing the gastroesophageal sphincter. This is the little doorway between the stomach and the esophagus which keeps everyone in line. When the doorway relaxes stomach acid leaks into the bottom of the esophagus and causes all sorts of trouble.  This is commonly known as “heart burn” and although it feels like it, the pain is not coming from the heart. That burning is the result of tissue damage because of acid reflux!

                                    [2]

This isn’t to say that no one can enjoy a good ol’ candy cane, just that it should be done in moderation- ESPECIALLY if you already suffer from recurrent heart burn! (Also, please don’t eat 20 billion grams of sugar on your own. That is a whole other conversation entirely.)   Everyone have a safe and fun holiday season!

- Dr.D

Do you suffer from headaches similar to the red pattern up there? Do they have a tendency to hurt on both sides of your head and pierce your eyes?  Pain medications never really touch it? If you’ve been struggling with headaches like these I might have the answer for you.

These kind of headaches are what are commonly known as Tension Headaches. Tension Headaches are not related to migraine headaches, but are caused by myofascial pain (muscle pain).  The pain in the head is not caused by anything wrong in the head, but is actually referred pain (pain from one place that is felt in another) from a muscle.  The guilty muscle in this scenario is the Upper Trapezius (or upper trap for the remainder of this post.) The upper trap is a large portion of the trapezius muscle that helps connect your shoulder to your head.

Everyone has a trapezius muscle and with that just about everyone at some point suffers from a tension headache. Tension headaches are famous because they tend to creep up on you when you’re busy and definitely do not want a headache! There are a number of factors related to why these headaches are so frequent, including but not limited to posture and stress.

This isn’t to say that ALL headaches are caused by myofascial pain. There are many causes for headaches, some complicated and some are simple (ex: dehydration is a very common cause, and easily fixed with water) The reason I bring tension headaches up is because they are incredibly common, but they are also very easy to work with! Chiropractors excel with the management of tension headaches. Treating the muscles and joints involved many times can make a drastic difference in both the frequency and the intensity of the headaches. Like I said, this is something that can be a constant problem but is also manageable; if any of this post describes what you’re going through we should talk.

Dr. D

Find yourself frequently yawning? Even when you’re well rested? Do you regularly experience low back pain that is always paired with a tight neck? Do you smoke? Do you have asthma? Are you someone who sucks in their tummy in an effort to look skinnier? (Be honest not) These questions, while perhaps not seeming relevant in a discussion about low back pain are important ones!

First a quick lesson on what breathing is and why we should care.  Respiration is a vital process, and one we do a lot (averaging between 15,000-20,000 times a day). This process relies on the lungs which supply the body with oxygen.  The process also requires many different muscles, and they rely upon a set pattern to work together to allow us to breath. Some muscles tighten up, while others relax- this allows us to make room in the chest for the lungs to work.  Of those muscles the most important for our purposes a muscle called the diaphragm. The diaphragm is a large muscle that goes from the bottom of the rib cage to the spine and separates your chest from the abdomen.  When we breathe in, the diaphragm lowers making room for the lungs to expand, and when we breathe out it pushes upwards forcing air out.

                                             Pretty neat system.

Done properly; deep breaths SHOULD push the diaphragm down which SHOULD push the belly outward- Belly Breathing.  Now stop and look at the people near you… I’ll wait. Odds are when they breathe in you will see their chest and shoulders rise.  This happens for many reasons (Respiratory illness, anxiety, or vanity to name a few) but many adults breathe using their chest and shoulders.

Breathing with the shoulders makes muscles mad. Muscles do not appreciate being over used, under used, or used improperly. Using shoulders to breath instead of the diaphragm develops a muscle pattern which causes pain.  Using any muscle improperly 15,000 times a day is going to cause a problem.

- The shoulders and chest do all the work, which causes those muscles to become overworked and very tight.

- The diaphragm gets lazy from its time on vacation (Caribbean sounds good to me too), and stops working as well.

- With the diaphragm on vacation the core (abs and low back) also goes on vacation. With the core on vacation, the low back loses stability and is more easily injured!

Muscle vacations: Start out nice,but they’re never ready to return to work at the end.

This might sound like a rare problem, but numerous studies have found that patients with low back pain exhibit altered breathing mechanics (shoulder breathing)[1].  Altered breathing goes hand in hand with chronic low back and neck pain!

“Oh NO! What can I do about it?!”

Good question. Proper Chiropractic adjustments along with the necessary rehabilitation at home can move you into the right direction to have control over persistent pains. If this reminds you of anything you’ve been struggling with, it can certainly be worth your time to have it evaluated.

Great video about responsible chiropractic treatment of Low Back Pain from the West Hartford Group. The WHG, Inc. is a scholarly, clinical practice think tank dedicated to the acquisition of the social, cultural and professional authority for the chiropractic profession where the Doctor of Chiropractic serves a vital role within the mainstream health delivery system as a non-surgical primary spine care physician dedicated to clinical excellence, intellectual honesty, professional integrity, ethical practice and the delivery of patient-centered, patient-safe, evidence-influenced care and best practice.

The West Hartford Group, Inc. is neither a political organization nor service organization but a think-tank that has put forth a model of chiropractic care that is consistent with that of the World Federation of Chiropractic and the Chiropractic Strategic Planning Conference. This model is of the chiropractic physician as the spinal health care expert within the health care system, i.e. society’s primary spine care physician.

It’s not news that chiropractors worldwide recognize the need for greater respect from the public, other health care professionals and various policymakers. What many people say is the missing key to solve this perceived inequity is our lack of general public trust which would permit our self-governance. When the public fully trusts a profession, then truth is what that profession says it is. The professional group defines itself and, without any fanfare or undue prodding, the public accepts this truth. That is the trust that marks cultural authority. Chiropractors have understood that this is a barrier for many years and many chiropractors have set out to build our cultural authority. In this episode, we speak with Dr. Michael Farrell, a chiropractor from the Buffalo, NY region on that subject.

LISTEN TO THE PODCAST HERE

Links for this show

Michael E. Farrell, II DC – practice website

Building Bridges to Cultural Authority by Arlan Fuhr, DC

How can chiropractic become a respected mainstream profession? The example of podiatry. Donald R Murphy et al

Book: Surviving in Health Care by Dieter F. Enzmann, MD Clearly written by a clinical doctor, this book first helps physicians understand the causes of changes in health care. Then, it explains how to devise a strategy in order to survive and prosper in today’s environment. It covers the entire spectrum of medicine, and encourages solutions that meet physicians’ individual circumstances. It focuses on useful tactics and specific actions, rather than quick fixes. Shows physicians how to formulate a strategy to survive and prosper. Includes discussion about cultural authority.

Chiropractic Summit

IHCPR

The separation is killing us. The isolation of chiropractic from the rest of health care is already difficult enough but we have huge pockets of isolation within chiropractic like cells of solitary confinement within an already secluded imprisonment. Further division continues to dilute something which is already weakened, already damaged. We need to find a solution to this or we are doomed to disappear. Dr. Steven Weiniger thinks the common thread needed to stitch the profession together, perhaps even unify chiropractic, lies in how we carry ourselves. Literally.  How we physically stand up in posture. Can positioning ourselves at the posture experts be the flag all chiropractors can stand behind, regardless of scientific or fundamental orientation?

Dr. Brett L. Kinsler, host of On The Other Hand Podcast, discusses this topic with Dr. Steven Weiniger of PostureZone.

CLICK HERE TO LISTEN or search OnTheOtherHand Podcast on iTunes.

• PostureZone.com
• Stand Taller, Live Longer book by Dr. Steven Weiniger
• Posture Rehab Seminars