Soft Tissue and Chiropractic

Many chiropractors fall into the one trick pony model of adjusting only, and ignore the soft tissue component of people's dysfunction. Or the nutritional needs, exercises, ergonomics or other things, but the title of this post dictates that I get back to the soft tissue...

Here's the deal--there are really four main pain generators when it comes to back or neck pain: joint, muscle, nerve, and disc. They all have their signature pain description (although there is some overlap), and they often cause pain in combination. Muscle, for instance, almost always gets involved.

Chiropractors are known for joint manipulation (the adjustment), which is often the treatment of choice for back and neck pain. Patients tend to self-select for that particular treatment, too. But when the soft tissues are involved they should be addressed. The most oft overlooked soft tissue component is something you may have never heard of called fascia.

Fascia is the connective tissue that surrounds your muscles and allows your muscles and skin to slide over each other smoothly. Injuries to the soft tissue can produce adhesions in the fascia which will cause movement restrictions which can eventually lead one down the path of dysfunction. Another problem with the fascia is the fact that it's relatively  avascular, that is, it doesn't have much blood supply. Tissues without much blood supply don't heal as quickly. What that means is after an injury muscles heal, but fascia can be deformed and cause lasting problems.

Enter Instrument Assisted Soft Tissue Mobilization (IASTM). I'm not the only Houston chiropractor to use it, but you can probably count on one hand how many do, and this is a big city. IASTM involves using a special set of tools to identify the adhesions in the fascia and then break them down. The tools purposely cause an inflammatory reaction which can bring blood flow to an area that doesn't usually get much blood. It also helps break down scar tissue which causes movement restriction.

What is it good for? I'm glad you asked. Just today I've seen two shoulder complaints, both of which are bordering on being fairly chronic. I also have a chronic tennis elbow (lateral epicondylitis if you want to be technical) patient who is responding nicely, and another with the same condition who is now pain free. Ankle sprains respond well, too. And that's just the extremity stuff. Fascia is often involved with chronic neck pain as well.

I love treating back pain and neck pain. When I get ten seconds to tell people what I do, I stick to those two bread and butter conditions. But give me 45 seconds and I'll get through headaches and move straight into extremity conditions that are usually driven by soft tissue dysfunction.

A Quick Word About Fish Oil

Omega 3's are the new black, and for good reason. However, it seems the reason is often lost on both the public and the supplement manufacturers. Allow me to clarify. And I promise not to get too technical...

To put it as simply as I can: the types of fats you eat eventually become a part of the cell membranes of all your cells. Those fats are then used as raw materials for the cell when it needs to make things, especially mediators of inflammation. What that means is you really are what you eat, and you can eat excess inflammation. Excess inflammation will eventually cause your genes to express sensitivity to pain, and if left unchecked, they'll also express most of the diseases of the west.

Cancer, heart disease, diabetes, and Alzheimer's disease are all, at least in part, inflammatory conditions that have taken ten steps too many. What disease you as an individual end up getting is contingent on your particular genetic influences. If heart disease runs in your family, then excess inflammation is very likely to show up as heart disease in you. As a matter of fact, the blood test for C reactive protein has historically been used to test for likelihood for a cardiovascular accident. The reality though, is that it tests for a marker of systemic inflammation, and when people have high levels of that marker they are likely to have heart troubles AND/OR a bunch of the other pathologies we'd all like to avoid.

Omega 3 fatty acids, such as those found in fish oil, are used by your cells to make anti-inflammatory chemicals that cause tissue healing. This is good. The specific omega 3's in fish oil are EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid, respectively). Flax oil, by the way, contains omega 3's, too, but not EPA or DHA, which are the fats that make it into your actual cell membranes. Flax seed oils go through a biochemical process that eventually yields EPA and DHA, but it takes on average about 11 times the flax to get the same amount of EPA/DHA into your cells as straight up fish oil. If you're a vegetarian, flax is the way to go, but if you're not, go straight for the fish.

Omega 6 fatty acids, on the other hand, produce inflammatory chemicals when plucked from the cell membrane and converted. You need some of those fats and they're not all evil or anything, but at the same time you need to limit intake. In a perfect world we would consume a fairly equal ratio of 6's and 3's. 4 to 1 is acceptable. The rub is that most of the foods we eat in America are chock full of omega 6's. Basically any grain product or food that ate a grain product like your grocery store beef are high omega 6. Same thing goes for vegetable oils.

The reason to take fish oil is to simply get some balance between the two. For this reason you should avoid products calling themselves EFA's, which stands for "essential fatty acids." They almost always have an equal ratio of 3's, 6's, and sometimes 9's (what you find in avocado oil). We eat too many 6's already, so you certainly don't need to take more.

Fruits and vegetables have a 3 favoring ratio, as do cold water oily fish like salmon and mackerel. Grass fed beef, which is getting easier to find these days (especially in Texas) has a good ratio, too. And it's not as expensive as you think. If you aren't ready to get that committed, then at least tilt the balance your way by avoiding grains and fried foods (at least foods fried in vegetable oil), and take some fish oil. Read my previous post about supplement quality, and know that we're here for your health at Green Chiropractic.

One more thing: if you have a group that would be interested in hearing more of this kind of thing, drop us a line at the web site. I'd love to make arrangements to spread the dietary love.

Back Pain Treatment Sans Crack

Low back pain is the number one reason for lost time at work, and it's getting worse since more jobs require marathon sitting sessions in front of computers like the one you're reading this post from right now. You should know that sitting puts more pressure on the lumbar discs than almost any other position (the worst is bending forward from a seated position and picking something up from the floor like a purse, for instance).

Statistically, the average back pain patient seeks help from a primary care physician. This typically leads to a round of anti-inflammatory drugs that may or may not help. Inflammation is huge when it comes to pain to be sure, but if the pain is being generated from a mechanical issue in the back such as a disc bulge, well, you need a mechanical solution. Enter Green Chiropractic.

There are plenty of reasons people avoid chiropractors, all of which will be addressed here in upcoming posts. Today, however, we'll focus on the fear of the crack that is often associated with spinal manipulation. I'll explain what the crack is, what it does, and why you should still come here if you're nervous about it.

Low back pain can be caused by many things, and is often the result of multiple factors coming into play. There can be a weakness in the protective muscles, along with a bulging lumbar disc. If the disc bulges far enough backwards it can compress the nerve roots coming off your spinal cord and lead to the classic numbness and tingling symptoms associated with sciatica down the leg or arm pain when you have a disc in your neck acting up.

Allow me to illustrate:

A scenario like the picture here can often be managed with spinal manipulation and exercise. The cracking style manipulation (often referred to as an adjustment by chiropractors) gaps the joints around the disc, and gives everything a little room to breathe, so to speak. The cracking sound is the release of gasses inside the joint that occurs when the joints gap, the same as when your knuckles crack. The resulting loss of pressure on the nerve root will decrease pain. However, there is an even cooler pain reducing mechanism that occurs--the nerves that transmit regular non-painful stimulus are fast conducting compared to the pain relaying nerves. But they enter the spinal cord through the same pipe. When the faster nerves are stimulated from the action of the joints gapping, the mechanical nerves overtake and dampen the signal of the pain-bringers. Sort of like when you hit your knee on something and then rub it to make it hurt less, but a lot better.

What I just described is one of the big reasons some people like to get adjusted on a regular basis. They feel "looser" and there is a general reduction in the aches and pains of life that we all get as we age. And that's cool with me.

However, not everyone is so hip to get their crack on, but they still need help with their back pain. Enter option two: Flexion/Distraction (F/D). I've always thought it should really be distraction/flexion, since that's the correct order of operations, but nobody asked me. F/D is essentially the use of a special table that uses mechanical traction  to open up the tissues around the disc. This has been proven to lower the pressure inside the disc which effectively creates a vacuum inside that can correct a disc bulge. See here for more info than most people would ever care to read. The opening around the nerve root has been measured to increase by 28% using this technique, and when it's just a millimeter of disc material pressing against a nerve root, 28% can be huge.

F/D is also helpful for people with bone spurs closing in on the nerve root, muscle tightness, and a number of other pain generators that can ruin your day. Determining the pain generator(s) is what we'll do on exam here, and usually doesn't require imaging or any other expensive procedures. But we'll save stuff for another post...

And as always, see our website for more info including where we are and what we do.