Tuesday, August 14, 2007


Well, as seems to happen on occasion over here at www.blog.dynamicfitness.us, I'm going to be tucking into a nice slice of humble pie today. Lemmie splain.

About a month ago I was thrashing away in the gym, very excited about the new program I was embarking on by my colleague (in the sense that Pop Warner footballers are 'colleagues' with guys like Tom Brady) Chad Waterbury. Now I was coming off something of a layoff, after several months of work on the bike, in the water, and on the road in pursuit of shaving a few seconds off my sprint-distance triathlon time, and as a result, I should have been careful.

Needless to say, I wasn't. After a too-short warmup, I jumped to near maximum weight on the incline dumbell press, shooting for a set of six reps. Right around rep four, I felt something give and a friendly little stab of pain in the front of my right shoulder. I put the weights down, pretended that it was not a big deal, and limped through the rest of my workout with minuscule weights.

I kept up the pretending for a few weeks, wincing when I had to hand anything over 30 pounds to a client, and hoping I'd wake up one day with the pain miraculously gone.

Didn't happen. A couple of times I leaned on my right arm while lying down and felt like my shoulder had dislocated (which has happened to me, twice. Very painful.) So finally I decided to go see a professional, and I opted for... a chiropractor.

I made that choice for a couple of reasons:

1) This particular D.C. came highly recommended by a very knowledgeable trainer whom I trust and

2) He came cheap, presumably because if he does a good job on me I'll recommend him to my clients, and they'll tell their friends, and they'll tell their friends, and so on, and perhaps, most importantly,

3) Whatever happened, I figured I could blog about it and write about my personal experience with chiropractic, which up to now has been exactly zero.

In part, my chiropractic experience has been limited because I've been a chiro-skeptic. It doesn't really make sense to me that ALL physical ailments can be traced to issues with the spinal column. I don't know much about physiology (or history, or biology, or any of those Sam Cooke topics) compared to some people, but a theme that seems to emerge over and over again is that it's hard to reduce the intricacy of the human body. So many systems, hormones, chemicals, moving parts. Remedies seem very condition-specific. So the idea that you could fix a bad knee by cracking the back seemed counter-intuitive to me.

Another reason I've been wary of chiropractic is that it involves manipulation of the body from the outside, which has always struck me something of an exercise in futility. In my experience, habitual movement patterns will eventually trump whatever external manipulation you impose on the body. Sure, as this video shows, you can grab your biceps tendon and thread it over the end of your clavicle (its optimal position, from which it often slips), but how long will it stay there if you keep repeating the behaviors that pulled it off course in the first place?

Here's a little SAT analogy: stone : river :: body structure : physical movement. That is to say, what you do habitually will eventually imprint itself on your bones, muscles and connective tissues just as surely as rushing water wears away at the rocks in the riverbed. So my strongest resistance to chiropractic medicine has been that whatever the chiropractor does to the body will shortly be undone by your usual physical activities.

Finally, I had the usual fear-of-the-unknown resistance to the idea that all that snapping and popping could really be all that good for you.

In sum I was the Sir Thomas More of chiropractic medicine.

But I was -- and remain -- willing to suspend disbelief in order to come up with a dispassionate assessment of the practice. So that's what this, and probably a few posts in the near future, will be about. Call it a little case-study.

Here's what I've learned so far:

1) My shoulder problem is only part of the equation. The doctor, whose name I won't give here right now because I don't want to slander the guy if my course of treatment is unsuccessful, explained that my habitual neck position was largely responsible for my shoulder problem. This was encouraging, but unsurprising, to hear. I knew going in that chiropractors believe that all problems are ultimately spinal. Some even believe that they're all tracable to L1 or C4 or T2 or some other individual vertebra, which seems like a rather extreme position. But in this case, the doc's assessment makes sense to me. Despite all my efforts to avoid such problems, I have "forward head syndrome," which -- I'll save you the Google search on such a confusing name--means that I crane my head forward habitually. This tendency compresses some nerves in my neck, which itself can cause shoulder pain, but also causes the gears of my clavicle and shoulder joints to grind a bit, like a bicycle with a slipped chain.

2) I need to do all the stuff that I tell my clients to do. This was a weird one. I mean, I figured just telling a few dozen people a week to do some stuff pretty much counted as me actually doing it, but no, apparently I've got to actually be aware of my own posture. Aware, for instance, that when I type away at my computer I shouldn't strain my head forward to see the screen better. And that poking my head out three inches when I'm driving at night probably won't help me see the road signs all that much better. So as I sit here typing away--which, I'm told is one of the root causes of my condition (which means I can blame everyone reading this for my FHS) I'm trying also to be aware of perching my head directly over my shoulders and not jamming it forward like some kind of nearsighted turtle.

3) Chiropractic isn't just about snapping and popping. On the first day, all the chiropractor did was massage the hell out of the front of my right shoulder. To the point of extreme pain, actually, so that my shoulder was sore for a couple of days. I didn't mind, really, and was glad that he didn't just jump to cracking me in half like a pretzel. On my second treatment, he did do some adjusting of my neck and spine (which was weird but actually felt pretty good), but he also handed me a couple of sheets detailing some exercises I could do to help tone up the muscles that keep my head comfortably in retracted-turtle position, and to help rehabilitate my tweaked shoulder. In a way, this was what I was hoping for: some suggestion that retraining behavior was at least as important as manipulating the body from the outside.

I have to admit, though, that after the neck-popping yesterday, my shoulder feels better than it has since my injury, and I don't have the weird radiating pains that I was getting right up until the appointment. Coincidence?

Today's cliffhanger will be, if I do these exercises religiously (and I don't know of any other way to do physical exercises of any kind), will my FHS and shoulder pain really go away?

Watch this space to find out.


Madley said...

My guess is YES! (There are some mighty wealthy D.C.'s out there -- must be doing SOMETHING right :)

Anonymous said...

There must be a clear distinction made when considering a DC. The two basics school of thought are (simplified here) always adjust vs. manipulate as little as possible. The words adjust and manipulate are used on purpose and are not interchangeable.

Forward head posture/syndrome can create a variety of compensatory changes, shoulder included. You raise a valuable point about physical activity undoing manual manipulation. Again there are a variety of variables all related to the underlying cause of kinetic dysfunction. I believe the key to effective chiropractic care is addressing the entire kinetic chain and treating each "broken link," not simply and only the spine.

High volume DC's will adjust many patients and provide that sense of euphoria that you have mentioned here. The failure to address the underlying cause typically results in a reliance on the DC for symptom based care. Chiropractors are not bone doctors - our treatments are targeted at the nervous system, by way of bone (i.e. Spinal cord - housed in vertebral column). Let me be clear when I say that I am not talking about bone on nerve (or garden hose kinking).

Research has shown there is a release of endorphins during manipulation. Pain is perceived by peripheral nociceptors, then travels through the spinal cord (spinothalamic tract) and into the limbic system, where it is registered as an emotional response. Manipulation provides a barrage of mechanoreception that overrides the nociceptive input which results in disafferentation and pain modulation. Therefore, it feels pretty good. Subsequently, if the cause of said pain or dysfunction is not addressed, pain and dysfunction will return.

Lastly, and arguably most important, is patient compliance. Given the DC has correctly identified what is going on, provides adequate physical medicine, manual manipulation and a correct exercise prescription - chances for success are decent. Chances are much better with patient compliance. There are 168 hours in a week, if you see a DC 3 times a week, 30 min each time, there are still 166.5 hours of time away from the office that the patient is responsible for and thus patient compliance is monumental.

I enjoy reading you blog as often as you post and I have found a tremendous amount of valuable information and thought provoking perspectives. My hope is that you will no longer be chiro-skeptic, but moreover a chiropractic success. Best of luck to you.

Andrew said...

Anonymous: Amazing post, thanks for your insights. Your point about patient compliance is interesting and warrants further discussion...in fact, I'll probably make it my next post.

Thanks for reading, and for your comments on my blog! Glad to see that some people in the health-care trenches are reading. Come back any time!