Tuesday, April 27, 2010

Get The Big Idea

BJ Palmer said “get the big idea and all else will follow”.  We are living in a time of incredible technological advancement. Every other day it seems we are hearing about some new understanding or discovery in all areas of human endeavor. We are living in an instant gratification culture, which seems to be accelerating monthly. It is hard  not to find your self being swept away in expecting everything you dream of or goals you set to become reality now. When these thing do not manifest them selves it creates an underlining discontent. No where is this more prevalent as in our young ones. Living in the information age, are not only fueling these phenomena, but also creating a thick layer of data smog. Having more information, which is being shoved at us in astronomical rate, does not enhance our understanding of “process”, a fundamental component of innate expression.

“Process” is one of those concepts that we can easily forget. Everything we encounter involves some process, and by definition there is a time element. Time is a concept that seams elusive in that we all have the same amount, which is too much for some and not enough for most. When we speak of time as it relates to an innate process, it can be variable, as we all know. The challenge we face is not to lose faith in the “process” when we become impatient with how long it takes. Chiropractic and its fundamental principles have to be one of the most unique and personal ways to observe this lesson.

Our lives are a process, a constant unraveling of an innate process within. Although we may fight it at times or deny the truth that “innate” constantly strives to express we must have faith in the process. We can all be reminded to be patient.

Monday, April 26, 2010

The Simplicity of Prevention

Everybody knows the health care system is in crisis. But while proponents on both sides of the political aisle battle onward, big medicine struggles to keep its piece of the pie, and health care costs continue to climb out of control. Insurance premiums have begun to rise by 30% beginning in September 09, due to the shrinking enrollment pool (Oregonian 8/30/09). Tired as we may be of listening to all the arguments, this is one problem that will not go away. Whatever the shape reform takes, if it does not change the fundamentals and only repackages the old with a new shiny cover, it will not take long before the system will show itself to be failing again.

When it comes to health care reform, the real question is this: What fundamental principle needs to be changed?

In order to create a real solution, what needs to be addressed, is the fundamental approach of the American health care complex and its continual, tunnel-vision focus on disease screening and management. Ever since the beginning of organized medicine back in the early 1900’s, the focus has remained on diagnosing and treating disease. Institutions grew in the study of pathology. Yes, this has been part of a noble call to understand the processes of whatever disease they were studying and find the magic bullet for each and every illness. Yes, there have been successes large and small along the way—the biggest of which was probably penicillin, saving hundreds of thousands of lives from the ravages of infection. However, the discovery and success of penicillin had a side effect; it launched one of the biggest and most powerful industries of our time, the pharmaceutical industry. With the promises of disease eradication and the end of human suffering, the pharmaceutical industry has slowly and insidiously come to influence every aspect of our lives. This industry has reaped huge profits, while the health of the average American is not even ranked in the G20 countries, despite Americans spending more on health care than any of those countries except for Morocco.

Sunday, April 25, 2010

Try the simple approach first

Many times our patients will present to us a multitude of seemingly complex symptoms. Patients with neck pain, many times, will have pain in their arms or hands, headaches, sinus problems, dizziness, just to list a few.  Patients with mid back pain, many times, will have digestive problems, such as acid reflux, pain with deep breathing, etc.

The Gonstead system of chiropractic focuses on first trying to normalize the function of two adjacent vertebras through a specific adjustment based on the physical finding of localized pitting edema, decreased intersegmental ROM, heat changes in the involved dermatome, and point tenderness.  Then we correlate these findings to the weight bearing X-rays.  This gives us the specific line of drive, torque and depth needed for a successful correction.  We find, most of the time, many of these associated symptoms will resolve on their own with improved function in the spinal biomechanics.  If not, an appropriate referral is made.

How can this help you? There is a simple exam that can be used to screen our patients, helping us to see whether there may be a spinal intersegmental dysfunction [subluxation] related to their condition.  The exam is simple and easy to perform.  Have the patient sit on a stool, shirt off, and starting at the base of the spine firmly palpate each spinous process of the spine.  Working up the spine, notice localized swelling and increased tenderness.  If there is spinal involvement, there will be a distinct difference in one segment relative to the other.

This simple test will help us to develop a clear understanding of our patient’s problem and possibly find a simple approach to solving it.

If you have any questions I would be happy to help.

Be Well,
Scott Conklin DC

Wednesday, April 21, 2010

Why Be Specific

In the world of manipulative medicine there has been a debate going on about the need to be specific. Some feel that all that needs to be done is a generalized manipulation to increase global ROM. This is very different when compared to a specific adjustment. In our office we follow the guidelines below.

1] First and foremost we want to find the primary vertebral segment that is involved. This is done through static palpation looking for point tenderness, pitting edema, muscle spasm. Then motion palpation is used to look for the altered biomechanics and fixation. Instrumentation is used that stimulates and then checks the neurological response of the involved segment.

2] We want to get an accurate count of that vertebra adjusted. This is imperative to ensure we are making the same correction over time.

3] Specific chiropractic adjustments depend on the correct line of drive and torque. Through palpation and weight bearing x-ray, we determine the safest and easiest way to adjust a segment into a neutral weight bearing position.

By following the above steps we try to adjust the primary problem or subluxation and not the compensations. Global manipulation of fixations will not correct the underlining mechanical deficiency. Correcting the cause will. Most times the primary problem is one or two vertebra.

Being specific and getting a good correction is our goal. Through the use of the Gonstead system we strive to find and correct the problem as quickly as possible.
If you would like more information on the Gonstead system or specific chiropractic please call.


Sincerely,
Scott Conklin DC

Tuesday, April 20, 2010

Treatment Plan Vs. Business Plan

We practice in a broken health care system. Some providers might not want to suggest chiropractic care to their patient, even if they think it could help, because they are afraid their patient will becomes part of some ones business plan and not have condition specific treatment plan. This does not have to be the case. Chiropractic is based on the bodies ability to heal itself . The focus is finding and correcting the spinal subluxation which interferes with the normal neurological function of the body. The question is what is an appropriate treatment plan. The answer is very case specific. There has to be procedures in place to help determine if the care is helping. This will be different in the acute case as apposed to the chronic case. In the acute case typically you should see some good improvement in the objective and subjective complaints in two to three visits.

Monday, April 19, 2010

Treatment Plans

What is an appropriate treatment plan in chiropractic? The best answer to that question is ‘the right amount’. When patients ask us how long it will take to feel better I tell them generally it will depend on three things;

  1. How long the injury has existed

      The sooner we can correct the subluxation before the formation of random scar tissue, the faster a patient will stabilize.

  1. How Healthy is the patient

      Generally the healthier the person, the faster their bodies are able to resolve the inflammation that results from the injury.

  1. Preexisting damage to the spine

      Many times relatively minor injury can persist because it has aggravated the underlying condition, this is due to allodynia (the modulation of pain in the cord so that 90% of pain signals never make it to the cortex to register pain, masking slow and developing problems).

The most important factor in any treatment plan is how the patient responds to care given. There must be a monitoring process in place to be able to evaluate the patient’s progress. In our office the patient is palpated, intersegmental ROM is checked and a heat differential instrument is used each and every visit. A treatment estimate is given after the first adjustment to see how they will respond to the correction given, and the plan is reevaluated weekly. As the patient shows a positive response, the frequency of the adjustments is reduced and an at home stretching/strengthening program is started.

Our office has three objectives;

  1. Find the cause of the problem and fix it as quickly as possible
  1. Train the patient to prevent future injury through stretching and strengthening
  1. Educate them on how the body’s system is interrelated to the nervous system from a functional level
If we can be of assistance or you would like to know more about Gonstead Chiropractic, please feel free to contact us.



Be Well,

Dr. Scott Conklin

Chiropractor

Thursday, April 15, 2010

Thoracic Anteriority/Rib Pain

Many times patients that are experiencing mid thoracic pain are given a diagnosis of a thoracic anteriority. This is then corrected by a common manipulative procedure where the patient is lying on their back and the doctor places his hand around the patient to the involved thoracic vertebra, then with his weight on the rib cage, a downward thrust is made. Some may tolerate the procedure but due to the lack of specificity and risk of rib injury, it is not the best way to correct a thoracic subluxation. The Gonstead system provides a much safer approach to correcting these types of problems.

When looking at the morphology of the thoracic spine it becomes clear that in order for a segment to move anterior with respect to the segment below there would have to be significant pathology. This is due to the coronal angle of the facet joints. Most of the time when you see a dishing of the thoracic spine it is due to extension compensation from a lower spinal segment. Another cause can be the imbrication of the long spinous processes in the mid thoracic region. Compensatory areas are often associated with tight and rope like musculature where the level of the problem will be edematous and flaccid on palpation. The best way to correct an intersegmental dysfunction of the thoracic spine is through careful analysis and specificity of the contact point. This can best be done with the patient in the prone position. Depending on the intersegmental relationships the contact point would be on either the spinous process or the transverse process of the involved segment. The line of drive would be through the disc plane line in a high velocity low amplitude type of thrust.

Patients sometimes will report that they have a rib out. Again the majority of the time it is due to the rotational component of a thoracic subluxation. By correcting the thoracic intersegmental dysfunction the rib pain will disappear. A good indicator that a rib has actually slipped posterior is acute pain on inhalation. If they do not have pain with breathing it usually is the thoracic segment. 

Please feel free to contact us if you have any questions.

Be Well
Scott Conklin DC

Wednesday, April 14, 2010

Full Spine Radiography

Whether an X-ray examination is needed or not is by necessity and by responsibility the judgment of the doctor based on clinical finding and need for further diagnostics. Whether sectional views are chosen or full spine the criteria is the same, medical necessity[ ].  The use of full spine x-rays falls under two broad categories: First, pathology, and Second, analysis.

The use of full spine radiographs is of value when clinical findings indicate multiple levels of spinal involvement [i.e. cervical, thoracic, lumbo-pelvic]. [ ] Full spine radiographs are considered to be of diagnostic quality[ ], with less radiation exposure to the patient [with current technology, exposure factors, film speed, shielding etc] compared to sectionals of the multiple levels involved[  ].

The analysis of the full spine films ranges from the medical radiology’s analysis of scoliosis and different perimeters to the different chiropractic line analysis systems [ ]. There are different studies that have looked into the validity of the different marking systems with mixed results [  ]. The controversies that exist point to the need for further research. Developing an understanding of the complexity of the spine and its many compensatory changes disserves chiropractic full attention. Full spine radiographs offers one of the unique views to study this challenging and complex structure in total. [ ]

Tylor JAM. Full-sipne radiography: a review. J Manipulative Physiol Ther 1993: 16:460-474

Phillips RB. An evaluation of chiropractic x-rays by the diplomate members of the American Chiropractic Board of  Roentenology. ACA J Chiro 1980: 14:S80-S88

Hardman LA, Henderson DJ. Comparative dosimetric evaluation of current techniques in chiropractic full-spine and sectional radiography. Manipulative Physiol Ther 1981; 25:141-145

Hildebrant RW. Chiropractic spinography. 2nd ed. Baltimore; williams&Wilkins, 1985.

Peterson C, Gatterman MI, Wei T. Chiropractic radiography. In;Gatterman MI, ed chiropractic management of spine related disorders. Baltimore: Williams&Wilkins, 1990:90-110

Plaugher G, Hendricks AH. The inter- and intraexaminer reliablity of the Gonstead pelvic marking system. J Manipulative Physiol Ther 1991; 14:503-508.

Plaugher g, Hendricks AH, Doble RW, Araghi HJ, Bachman TR, Hoffart VM. The effects of patient positioning on radiographically evaluated static configurations of the pelvis. Proceedings of the 1991 Conference on Spinal Manipulation, VA 1991.

Hildebrandt RW. Chiropractic spinography and postural roentenology-part 2 ; histroy of development. J Manipulative Physiol Ther 1981; 4:191-201.

Nelson RD. The APFS x-ray veiw. ACA J Chiro 1980; 14:S39-41.

Thursday, April 8, 2010

Headaches

Most practitioners that deal with the headache sufferer understand the challenge and the devastation headaches can have on a patient’s life.  Chronic headache sufferers are becoming more prevalent as the stressful conditions in our society increase. 

In my twenty years in practice, I have seen many cases ranging from mild tension headache to severe migraine type.  There are many things or a combination of things that can be triggers for headache.  We play detective trying to discover the causes.  These triggers range from food allergies, changes in eye sight, environmental allergies, stress and pathology just to name a few.  However, I would like to discuss one of the most overlooked major triggers, biomechanical dysfunctions of the spine.  I have found that 90% of the patients with headaches of all types have some level in their spinal column that is subluxated (an intersegmental dysfunction of two vertebra causing inflammation).  Due to the relationship of the nervous system and the spinal column, dysfunctions in the normal weight bearing biomechanics can have a profound influence on triggering headaches.  This may be due to the compensatory muscle tension as the body struggles to stay balanced, or from the increased nociceptive input from local inflammation and swelling affecting the tissues at a specific level.

Spinal biomechanical dysfunction is something that should be screened for in all headache patients.  Gonstead chiropractic is a safe and effective way of correcting this aspect of headache triggers.  A careful and thorough evaluation of the spinal biomechanics is essential if these patients are going to be helped conservatively.  Many of the medications currently used are expensive and can have potential side effects.  Chiropractic offers a simple, safe alternative that focuses on the cause and not just the symptoms.

Please give us a call if you would like to know how to screen your patient for this potential problem.

Be Well,
Dr. D. Scott Conklin