Category Archives: Muscle & Joint

Chiropractic, a second look

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Many D.C.s are great. If you are seeing a chiropractor and have had good success, fantastic! I am the last person to interfere with something that’s working. But if your “genius” has been “fixing” you for years and you are still the same as when you started… it might be time to rethink chiropractic.

Sure, you get temporary pain relief and a nice endorphin rush… but does it last? And is there a cost?

I am NOT a fan of the subset of chiropractors who indiscriminately and overzealously use HVLA adjusting (high-velocity, low amplitude – you know, that violent cracking). Low-force chiropractic like Network, BGI, and activator is absolutely safe, and there are lots of other techniques besides HVLA that are fine. HVLA is appropriate when used to correct an acute injury, like putting a dislocated shoulder back in the socket, but it should not be a frequent therapy. Repetitive stress of supportive ligaments and the resulting inflammation will actually damage the joint.

My information comes from my time at chiropractic school (I completed the first year, including the entire series of cadaver dissection, with nearly straight A’s), my knowledge of functional anatomy as a certified personal trainer and amateur bodybuilder, my 10 year partnership with an Osteopathic medical doctor, my experience seeing patients who have been damaged by repetitive HVLA, and discussions with many physicians of all types. I welcome input from any chiropractor who is interested in a fact-based discussion.

Personally speaking, I suffered a terrible injury when my car was broadsided in the first week of chiropractic school. Their treatments were making me worse, and the more I learned in school, the more I understood why.

1) It doesn’t treat the cause of the problem. Bones don’t move by themselves. If a bone is repetitively out of place, it’s because there’s a tight muscle pulling it that way, or a weak muscle failing to hold the bone in place. Jamming the bones back will cause micro-tears of that tight muscle. It feels good immediately, because you get a nice adrenaline rush along with your temporary fix. An enlightened chiropractic teacher compared HVLA to the shock and rush you get from a shot of vodka. Addicting, but not necessarily good for you. Unfortunately, as soon as the muscle goes back to its usual tight, spasming self, the bone will be pulled back out of alignment. That’s why you need to go back to the chiropractor the next week. Acupuncture and medical massage use the neurological system to retrain those tight muscles, so real healing can begin.

2) Our ligaments and tendons are there for a reason. They provide much-needed joint stability and hold us together. Repetitive HVLA weakens them, and can destroy your joint integrity. We all know that an ankle, having been sprained three times, is pretty much guaranteed to twist again. You do not want that floppiness in your spine. You should not able to crack-crack-crack your back simply by stretching. That’s called hypermobility and it means you can move too much. If you have already been damaged by too much HVLA, you will need to strengthen your back and abdominal muscles to help support those loose ligaments and tendons. Hypermobile backs are more likely to suffer a serious injury if you have an accident (this is what happened to me!).

3) Your reflexes work against HVLA. Quickly yanking on a muscle – even a relaxed one – can cause damage and inflammation. There’s a built in protective reflex that tightens a muscle when it is suddenly lengthened. You can feel this: Fold your friend’s arm at the elbow and put your hand on their bicep. Straighten the arm quickly, and you can feel the bicep twitch under your hand. Now imagine that happening to an already-sore neck muscle being snapped.

4) The pop means nothing. The cracking sound doesn’t necessarily mean you’ve been adjusted properly. It’s called cavitation, and it means that nitrogen gas, naturally occurring in your joint fluids, has been released. A similar thing happens when you open a can of soda. The sound means the bones have been rapidly separated (opening the joint space) and then have come back together. They may have come back to the same position, a better one, or a worse one. Misalignments, when corrected gently OMM style, do not make a cracking noise because the joint space is eased into the correct position rather than violently forced.

5) First, do no harm. Some chiropractors don’t bother to diagnose which level is dysfunctional. They just “shotgun” you by cracking all the vertebrae in your spine. Then they flip you over and do the other side. Why cause stress and create inflammation in a joint that’s working? Added bonus: Whenever you have inflammation, scar tissue forms. Trauma (HVLA) every week leads to more and more scar tissue building up. That’s the last thing you need when you’re already hurting.

6) With repetitive strong adjustments, your body becomes dependent on that input. In chiropractic school we joked about “welfare spines.” I had a discussion with an instructor who was brutally blunt about the temporary nature of his treatments. “Of course they have to come back. That’s how you buy your boat.” I found that model of “medicine” distasteful and unethical. I prefer to help the body heal itself. I love acupuncture and OMM because they truly correct how your muscles function.  Combined with proper exercise*, this creates a body that is strong and capable of bouncing back after a minor injury. I don’t want to see you every week for the rest of your life. I’d prefer to get you better and self-sufficient, and then stay in business by fixing all your friends and family. :)

BTW:  “But I can’t help it!” When you are out of alignment, your body will naturally feel compelled to snap itself back in place. After my injury I used to violently crack my neck and back all the time. It never really solved the problem, though… refer to point 1 above! The good news is that the desire to self-adjust melted away when my muscles – and more importantly, the neurons controlling those muscles – were corrected by acupuncture and Osteopathic medical massage.

*Exercise is essential to strengthen weak muscles, remind tight ones how to relax, and get all your muscle fibers integrated and working together. We are built to move! I know firsthand how pain makes you want to curl up on the couch and wait for it to heal, but the hard truth is that it won’t really repair until you put in the work. Get on an anti-inflammatory diet, see me for basic physical therapy-type exercises, and start walking! Better yet, see an expert personal trainer.

GB-34 (any muscle / tendon issue, knee pain, Damp Heat)

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GB-34 is Yang Ling Quan (Yang Mound Spring). The name refers to its location on the Yang aspect of the leg. GB-34 is the Ruler of the Sinews (musculoskeletal system), so it will treat muscles, ligaments, and tendons anywhere in the body. It’s particularly effective for knee problems, due to its location. GB-34 can also be used to treat issues like jaundice, nausea, and vomiting. It’s also good for treating Damp Heat, but that’s a fairly complicated Chinese medicine concept related to infection. Ask me if you’re curious.

GB-34 is about an inch anterior and inferior to the head of the fibula. First, find the head of the fibula. This is a knob of bone on the side of your leg,  just below the knee, towards the back. Now slide your finger forward and down into a small dip. It will be tight or tender if treatment is appropriate: Press firmly for 20-30 seconds, with healing intention.

Du-4 (warm the Yang, lower back pain, low energy, infertility or ED)

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Mingmen, the Gate of Life (AKA Du-4) is located in the center of the spine, just below the 2nd lumbar vertebrae. It’s used for building Yang, treating infertility or sexual issues such as erectile dysfunction, and for lower back pain or weakness.

Be careful stimulating this point if you are using acupressure, since it’s often tender.  Applying heat can be useful, especially If you tend to be cold. In my clinic, of course, I use acupuncture and an infrared therapy lamp. At home, you can direct a warm shower stream onto it or use a microwavable rice bag (I have them at the office if you need one).

Also good for lower back pain: LV-3, BL-40 and GB-34.

 

Ergonomic & Repetitive Stress Injuries

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Repetitive stress injuries happen when you perform the same movement over and over for an extended period of time. Ergonomic problems are when your position or movement is counter to what your body does naturally. Common examples include carpal tunnel syndrome from using a computer, or a swimmer’s bad shoulder. Sitting itself can cause problems if you do it too much. To avoid injury:

1) Break up the repetitive nature of your motions. Get up and do a lap around the office (or house) every hour or so. Change your routine: Instead of typing on Tuesdays and filing on Wednesdays, do a little of each both days, so you aren’t making the same precise movements for hours. Can you switch to the other side or hand? Even small changes can make a difference. For example, my knitting friends who have trouble will opt for a different size needle (which affects hand position and motion) or even type of project. The more variety the better.

2) Double check your ergonomic situation. It may be helpful to get someone to take a picture of you while you’re working at your desk so you can see your own posture. If you use the phone, try a headset. Sitting at your computer, you should be looking straight ahead at the top third of the screen. If you are looking up or down, adjust either your seat height or the monitor. Your elbows should be resting at 90 degrees, and your wrists should be straight. Having them bent down or cocked back for the keyboard increases strain. Your knees should be at hip height or just above. If your chair is too tall, use a footrest. If you have a penny-pinching boss, you should know that OSHA can send out an ergonomic expert (free!) to suggest cheap/free fixes in your office.

When playing sports or working out, consult a coach or professional trainer to be sure you’re using good form. Learn the anatomy relating to your activity. In addition to preventing injury, your performance will improve! I used to be a bodybuilder and certified trainer, so feel free to ask me if you have any questions.

3) Stop as soon as symptoms start. Give your body a chance to heal. Ice and anti-inflammatory drugs like ibuprofen may be helpful here, as will an anti-inflammatory diet. Likewise, get care early. A new problem is always easier to chase away than an entrenched one. Myofascial release will free up adhesions. Osteopathic medical massage can retrain your tight muscles, and acupuncture will reduce inflammation.  Rest. Stretch gently, and do any physical therapy exercises your healthcare professional recommends. Try to avoid that activity for a while.

Frequently re-examine your routine and ergonomics to identify any areas that need improvement. By nipping problems in the bud, you can prevent a long-term aggravation.

TB-5 (immune support, neck pain)

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The Triple Burner channel relates to the fluid in the upper, middle, and lower body. I believe it correlates to the lymphatic system, since it plays a large part in immunity.

TB-5 will help you fight off an infection, and relax the back of your neck.

The 5th point is named Wai Guan, or Outer Pass. Think about a pass through a mountainside: It lies between the radius and ulna bones of your forearm, about 2 inches from the wrist. “Outer” refers to the back (posterior, Yang) side of the arm, as opposed to the front (anterior, Yin) surface.

Press TB-5 firmly with a fingertip for 10-20 seconds to stimulate your immune system if you have a cold, flu, or any other type of infection. Allergies can benefit from using this point to regulate an over-active immune system. It’s also helpful for aches on the back of the head and neck.

LV-3 (irritability, hormones, leg, hip, or lower back pain)

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LV-3, Tai Chong (Great Surge)

Liver 3 is found on the top of the foot, between the long bones of the 1st and 2nd toe. It’s a very important point for the Liver, and helps to move stuck energy from the waist down. You can use it to treat lumbar back pain, leg or knee pain – pretty much any stagnation in the lower body. It’s also great for red eyes and other “Yang Rising” problems, and for dysmenorrhea & hormonal imbalances. LV-3 is an excellent point for treating irritability and grouchiness, particularly if it’s due to hormonal issues like PMS.

LV-3 – “The grouchy point” – will also soothe the lower back.

When used in combination with LI-4, these points are called the Four Gates and can really blast out some stuck Qi. DO NOT use these points if there is any possibility of pregnancy, since they can induce a miscarriage. In fact, they are some of my favorites for evicting overdue babies. It will also increase menstrual flow if the patient is having her period.

Press firmly for 10-30 seconds.

The Shoulder

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Anterior (front) view of the bones of the shoulder joint.

We can do amazing things with our arms. Lift them overhead, cross our chests, even link our hands at our spines. In fact, the shoulder is the most mobile joint in our bodies, thanks to its “ball and socket” configuration. See how the head of the humerus (upper arm bone) fits into the scapula (that triangular bone in your upper back) like a baseball into a glove? It can spin on the smooth, round surface to provide a spectacular range of motion.

The posterior (back) view of the shoulder.

Just as with national politics, there’s a trade-off between freedom and stability. The complexity of this joint makes it prone to a variety of injuries. Cartilage lines the articulating joint surfaces to create a smooth track for movement. If torn, it takes a long time to heal and may require surgery. There’s the bursa, a fluid-filled sac that provides cushioning. Inflammation here, called bursitis, can be very painful. Rest, ice, anti-inflammatory drugs, and acupuncture are the best treatments (of course an anti-inflammatory diet will help, too). The well-known rotator cuff is actually a set of four deep muscles that stabilize the joint and work to rotate the humerus. Three (supraspinatus, infraspinatus, and teres minor) can be seen in the drawing of the back view of the shoulder. The fourth, subscapularis, attaches to the front of the scapula and goes to the front of the humerus and the joint capsule. With a minor tear, they will require rest and then specialized exercises. Severe tears require surgical intervention.

Overtop the rotator cuff is a layer of larger muscles, such as the latissimus dorsi & teres major (back), and the pectoralis muscles (front), and the deltoid (that roundy bit at the corner). These are your heavy duty movers. Ironically, since the lats and pecs both attach to the front of the humerus, unbalanced exercising can lead to an internally rotated (palms towards the back) shoulder, or “ape” posture. This is a great example of the importance of an intelligent, balanced workout plan. Then of course there are all the muscles that continue down the arm to control the elbow, including the triceps and biceps.*

If any of these muscles are dysfunctional, the bursa is irritated, or the cartilage is torn, you can have shoulder pain and loss of range of motion. Connective tissue can adhere, and scar tissue builds up over time. In extreme cases, you can develop Frozen Shoulder, which is exactly what it sounds like. It just won’t move. There are other causes of shoulder pain, too, ranging from nerves being pinched at the neck to gallbladder disease, but these musculoskeletal problems are the most common.
Acupuncture can reduce inflammation, increase bloodflow, relax tight muscles, and speed healing. I can also perform Osteopathic medical massage to break up scar tissue, release myofascial adhesions, and retrain the neurological system. This allows chronically tight muscles to return to normal. In most cases, therapeutic exercise is important for complete healing.

*Please note that I’m simplifying the anatomy quite a bit  for the purposes of this article. If you’re interested in all the marvelous details of our bodies, I highly recommend Netter’s Atlas.

The Knee

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Let’s talk about the knee joint. It’s not quite as complicated as the shoulder, because it doesn’t move in as many directions. Having that kind of mobility with all of our body weight on top of it… well, that would be a recipe for disaster.  Instead, we have a modified hinge joint. The knee folds, but it also twists a little bit. The trick is keeping this twist under control.

Front view of the knee joint.

Collateral ligaments run along each side, and the cruciate ligaments (named so because they form a cross) inside the joint create stability. Strong quadriceps (a set of 4 muscles on the front of thigh), hamstrings (three muscles in back of thigh), adductors (inside) and abductors (outside) also support the knee. Slick cartilage lines the surfaces where bones meet. The meniscus, a pair of special horseshoe-shaped cartilage structures, help absorb shock and guide the movement of the femur. And there’s a bursa on top of the patella (kneecap) to provide some extra cushioning. Pretty neat design, huh?

Sp-9 treats the knee, and drains Damp (a concept in Traditional Chinese Medicine).

If your gait is off, it can affect your knees and eventually your hips and back. Good shoes are important for knee health. Avoid heels as much as possible. If you have flat feet, use shoes with good arch support. To prevent injury, frequent light workouts are best. If you are a bigger person or have joint issues, try to reduce impact: walking or using an elliptical trainer is better than running, and staying on grass or a rubber track is better than concrete.

 

 
    Did you know that babies are born without kneecaps? They have a cartilage wedge but it doesn’t ossify (turn to bone) until about 3 yrs old. Lucky for them – It makes crawling around on a hard floor much more comfortable.
Acupuncture can reduce inflammation, increase blood flow, relax tight muscles, and speed healing. I can also do Osteopathic medical massage to break up scar tissue, release myofascial adhesions, and retrain the neurological system. This allows chronically tight muscles to return to normal. In most cases, therapeutic exercise is important for complete healing.

Acupressure you can do at home: LV-3

*Please note that I’m simplifying the anatomy quite a bit  for the purposes of this newsletter. If you’re interested in all the marvelous details of our bodies, I highly recommend Netter’s Atlas.

Unexplained pain & its various causes

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There are many reasons your body can hurt. It’s really frustrating when you don’t understand why, but often unexplained pain just means it doesn’t fit into a nice diagnostic box. We’re all familiar with muscle strain/sprain, fatigue, inflammation, and arthritis… you probably already know that acupuncture can help with these. Less understood by the general public are these causes of pain:

Viscero-somatic referral (Viscero= organ, Somatic=relating to the body): In this case your brain misreads a distress signal, so an organ problem feels like a muscular problem. The most famous example is the heart attack that creates an aching arm or jaw, or bone cancer masquerading as a back strain. Pain that doesn’t respond to treatment needs to be assessed by a medical professional to rule out dangerous causes.

Chronic spasticity: Healthy muscles are constantly changing their level of tension. They work with constant feedback from the cerebellum (part of the brain) to make tiny adjustments. This is how we keep our balance and perform tasks smoothly. When a muscle is tight for a long period of time, however, its setpoint changes. It thinks being tight is normal – this is called spasticity. It leads to stiffness, pain, and misalignment of bones as they are pulled out of place. Blood flow is blocked, creating painful ischemia. Tight muscles and misaligned bones can pinch nerves causing “electric shocks,” tingling, or numbness. This is what I see most often when people come in with unexplained pain. There’s nothing to show up on an X-ray or MRI, because the problem is functional, not structural. Massage is a great temporary relief, but to really fix it you need to treat the cause of the problem, the neurological setpoint. Acupuncture and Osteopathic-type medical massage remind the nerve controlling the muscle how it’s supposed to behave. Once the muscle relaxes, bones return easily to their proper place, and the body can heal itself.

Fascial adhesions: Each muscle fiber has connective tissue, called fascia, surrounding it like a layer of Saran wrap.

Connective tissue (white) and muscle fibers. When fascial adhesions form, it can cause unexplained pain.

Connective tissue (white) and muscle fibers

It may help to picture a muscle fiber as a drinking straw in a paper wrapper (sheath of fascial connective tissue). At each end, that fascia becomes our tendons. These sheaths are supposed to slide past each other as muscles move. With long periods of no movement, if the muscles are spastic, or if there’s an injury, they can stick together and form a fascial adhesion. When your muscles are shrink-wrapped together, it can cause muscle stiffness and unexplained pain. Some people like to get in and dig the adhesions apart, deep-tissue massage style. That works well in the short term, but it also causes inflammation… which causes scar tissue… so the adhesions reform.

Myofascial release can help with unexplained pain.Myofascial release, a type of medical massage, uses a more subtle approach to slide the layers apart. I love doing this type of work because the result is immediate freedom of movement with no pain and no boomerang side-effects.

Emotional causes of pain: Sometimes the pain of an injury lasts far longer than it logically should. This usually points to an emotional attachment. The brain literally links the muscular dysfunction with the memory, and the unresolved post-traumatic stress around the incident will actually prevent the body from completely healing. This can happen with gradual, cumulative injuries too: Imagine a tight neck from a job you hate. Patients will frequently have an emotional release when we start working on the physical site. They may start crying, giggling, getting angry, or suddenly find themselves terrified “for no reason.” Once we get those remaining feelings flushed out, the muscles and tendons often recover rapidly. If you feel something emotional happening during a session, let it out! Releasing pent-up emotions is therapeutic for your body as well as your soul.

Doctors used to blow off psychosomatic illnesses as “all in your head” and not worth treating. The medical community now has a better understanding of the interplay between the mind and body. It’s a two-way street, and they affect each other profoundly. Chronic pain will screw up your neurotransmitters (chemicals in your brain) and temporarily change your personality. Likewise, an overthinking, worried mind can trigger digestive troubles like IBS (Irritable Bowel Syndrome).

If you have a chronic injury that isn’t healing, it’s worth reflecting for a few minutes. Is there anything your body is trying to tell you? If so, consider talking it out with a therapist or a good friend. Acupuncture can help balance your emotional life, but there may be some work needed on your part, too. Of course you’re welcome to discuss anything in our sessions, and your confidentiality is always assured.