When I am performing needling on a patient for the first time, I am regularly asked what the difference is between acupuncture and dry needling. For many, these two treatments are one and the same, but despite their similarities, they also have their differences.
Acupuncture is one branch of Traditional Chinese Medicine (TCM), the others being herbal medicine, nutrition, movement (Qi gong), and manual therapy (cupping, tui na massage, and gua sha). Acupuncture involves inserting needles at specific points and utilizes the ‘meridian theory’ as its basis for treatment. On an acupuncture chart you will notice lines, or meridians, drawn throughout a person’s body. A meridian may travel from the hand to the head, the foot to the abdomen, or from one end of the spine to the other. Meridians connect different parts of the body to each other. Each meridian is linked to an internal organ, such as your liver, lung, or heart. There are 12 primary meridians, one for each organ, along with 2 ‘extraordinary’ meridians, which are commonly used in practice.
Based on the theories of TCM there is an energy force called ‘Qi’ flowing along the meridians. Qi is responsible for keeping our tissues healthy, youthful, and disease free. The smooth flow of Qi along the meridians is imperative for optimal health. When Qi does not flow well or is stagnate, pain, injury, and disease can arise. When a needle is used to stimulate an acupuncture point in clinical practice, the goal is to restore the flow of Qi along the meridian. When Qi is flowing freely throughout your body, you will feel vital and energized.
The origins of dry needling and trigger point theory are closely related. Trigger point theory refers to the idea that pressing on a tight, tender band of muscle tissue will often refer pain to a different area of the body. For instance, stimulating a trigger point in the upper trapezius muscle of the shoulder may cause pain in the temporal region of the skull. Researchers began mapping these ‘referral patterns,’ which appeared to be consistent from person to person. Janet Travell and David Simons are arguably the two most influential contributors to trigger point theory and their pain referral charts are still widely used today. Early researchers of the trigger point theory used needle injections of local anesthetics to map the associated referral areas for each trigger point. Interestingly, the treatment benefit would often outlast the anesthetics known treatment time. It was at this point researchers realized it was actually the needle insertion into the trigger point, rather than the anesthetic itself, providing the therapeutic effect. Dry needling is referred to as ‘dry’ because there is no anesthetic or saline injection used during the needling treatment.
Similarities Between the Two
In general, the local effect of the needle is the same whether you are performing acupuncture or dry needling. At a microscopic level, the needle is causing a local micro-trauma or small injury to the tissues, which stimulates the body to send blood and healing products to the area. Needling is a viable treatment for areas receiving poor blood flow, such as tendons, ligaments, and the periosteum of bone. By stimulating blood flow to these traditionally ‘avascular’ or low blood flow areas, the patient’s recovery from tendinous and ligamentous injuries can be accelerated.
In my practice I use a combination of acupuncture and dry needling. I often do dry needling at the site of pain, and then utilize local, adjacent, and distant Chinese medicine acupuncture points to help move Qi and blood throughout the body. As a chiropractor, I utilize many spinal points to help with painful conditions of the neck and low back. Combining a spinal chiropractic adjustment with needling in the same area is extremely helpful for patients. Acupuncture and chiropractic care complement each other wonderfully. Chiropractic care helps the neurologic and orthopedic systems function better, while acupuncture helps with systemic health by improving the flow of Qi and blood throughout the body. Combining a Western orthopedic approach with an Eastern Chinese medicine approach is an excellent way to help patients achieve optimal health.
Post Written by Dr. Riley Kulm DC. Check out his bio here.
The standard lipid panel consists of four different numbers – total cholesterol, LDL, HDL, and triglycerides. LDL and HDL refer to ‘low density lipoprotein’ and ‘high density lipoprotein’ respectively. LDL and HDL are the carrier proteins for cholesterol in the body and help to make sure the fat from our diets ends up in the cells needing the energy. Triglycerides are fat molecules circulating in the bloodstream. When triglycerides in the bloodstream are abnormally elevated due to poor diet, obesity, or type 2 diabetes, there is more deposition of fat in the tissues leading to weight gain. Total cholesterol is the sum of LDL, HDL and 20% of your triglyceride level. Looking at the values of these different numbers can give valuable clues into heart disease risk and overall metabolic health.
When assessing a lipid panel, I like to use the numbers offered by functional medicine practitioner, Dr. Catherine Shanahan, M.D. in her excellent book, Deep Nutrition: Why Your Genes Need Traditional Foods. She suggests the following optimal lab values for the standard lipid panel:
-Triglycerides less than 150.
-HDL greater than 45 in men and greater than 50 in women.
-LDL: HDL ratio less than 3 to 1.
A high total cholesterol is not concerning if the ratio of LDL to HDL is maintained below 3. Likewise, a high LDL number does not necessarily indicate an increased risk of heart disease if the ratio is maintained. It’s important to remember the gold standard test to determine the health of your lipid cycle is the LDL particle size count. The test assesses for damage to LDL particles – a damaged LDL particle is a smaller one. Damaged LDL particles are more likely to cause inflammatory reactions in the arterial walls leading to plaque formation and atherosclerosis. The LDL particle size count is rarely ordered by physicians due to the cost, however it remains the best test for assessing heart disease risk.
Many physicians put their patients on a class of drugs called a statin which decreases the body’s natural production of cholesterol, especially the type of cholesterol bound to LDL particles. The problem with this is cholesterol is an important building block for many cells in the body including our steroid hormones which include testosterone, estrogen, and cortisol among others. Additionally, the brain contains the highest amount of cholesterol on the body, meaning lowering cholesterol with a statin drug may impair brain function and induce cognitive decline. Statins come with a host of side effects including muscle aches and pains, altered liver enzymes due to liver damage, and increased risk of developing type 2 diabetes. This is why it is so important to match your most recent lipid panel up with the numbers I give above before agreeing to start taking a statin drug. In future posts I will explain some of the diet and lifestyle factors you can adopt to help normalize the levels in your lipid panel without having to take a statin drug.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Sleep is the most important cornerstone for optimal health. Without the foundation of a healthy night of sleep, all other health interventions, such as nutrition and exercise, will fall short. Our memory, cognition, and ability to learn new tasks all depend on healthy sleep. ‘Sleep hygiene’ refers to the quality and quantity of sleep you are getting each night. I recommend my patients get 7 to 9 hours of sleep each night, depending on activity level, as well as season. During the winter months, you should opt for close to 9 hours of sleep. During the summer months, 7 hours of sleep may be adequate since days are longer and the nights are shorter. Additionally, more sleep is needed the more active you are as it is important to allow your body adequate time to recover after difficult workouts. When helping patients improve their sleep hygiene, there are three interventions I use most frequently, outlined below.
First morning sunshine
Going outside first thing in the morning with as much skin exposed as possible stimulates the body’s release of the hormone cortisol. Cortisol is known as our ‘awake hormone’ and gives us the energy to start our day. Cortisol naturally starts to decline around lunch time, and by the evening levels should be low as it starts to get dark and we prepare for sleep. Cortisol becomes problematic when levels remain high in the afternoon. When cortisol levels remain elevated, it becomes a stress hormone and causes us to crave sugary and fatty foods. Additionally, high levels of our ‘awake hormone’ in the evening work against us falling and staying asleep. The best way to ensure cortisol levels are low in the evening is to secrete as much as possible in the morning. Sunshine stimulates cortisol secretion, meaning it is optimal to get plenty of sunshine in the first half of the day.
Turn off electronics at least 90 minutes before bed
Blue light exposure tricks your brain into thinking it is still light outside, decreasing the release of your sleep hormone, melatonin. I recommend turning off all electronics 90 minutes before bedtime. Not only does blue light manipulate our brain into thinking it’s light outside, but often the things we are looking at on our screens, such as social media feeds or work emails, stimulate our brain in a way making sleep difficult. Scrolling through your social media feed causes a release of the neurotransmitter, dopamine, which plays a role in the brain’s reward system. When dopamine is released, the brain is stimulated and there are feelings of pleasure. While satisfying at the moment, excessive release of dopamine prior to sleeping will make it harder to fall asleep and stay asleep. Therefore, put those phones away before bed time!
Read fiction before bed
Reading before bed is one of the best ways to prepare our brains for sleep. Giving the brain a singular point of focus, such as a captivating fictional story, will allow you to stop thinking about the stresses of work and life and prepare your brain for sleep. With this in mind, reading materials related to work or checking emails will continue to stimulate our minds and keep us thinking about the day. Consequently, I recommend reading fiction. It is a better way to take your mind away from the pressures of the day. If you are a fan of historical fiction like myself, check out Ken Follet’s new novel, Pillars of the Earth.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Many people experience popping in their hips. Most patients come to the clinic complaining of back or knee pain, and a popping hip may be a secondary complaint. Although typically not a significant pain generator, popping in the hip is a sign of an underlying dysfunction in the hip needing to be addressed. If the popping in the hip is not attended to, more serious orthopedic issues may arise down the road.
There are three main causes of a popping hip – external, internal, and intra-articular. External is most frequent and refers to the iliotibial (IT) band snapping over the greater trochanter of the femur. Internal is also common and refers to the iliopsoas (hip flexor) tendon snapping over a bony prominence on the pelvis or at the lesser trochanter of the femur. Intra-articular is least common and refers to a floating loose body within the joint such as a torn labrum. External and internal variations are often due to gradual onset, whereas an intra-articular loose body is often due to trauma. There is a higher incidence of hip popping in females, especially those who perform sports requiring repetitive flexion and extension of the hip such as gymnastics, dance, soccer, and running.
How to fix it
Popping in the hip is often related to a stability issue in the hip or the core. To address this, work to improve your hip stability in all three planes of motion. Train slowly, controlling the motion to avoid the pop. Train only through ranges of motion where you can avoid the pop, and gradually increase the range of motion as your stability improves. The external hip pop (ITB over greater trochanter) is often related to poor hip stability in the frontal plane (abduction/adduction), and increasing strength of muscles such as the gluteus medius will be helpful in decreasing the external hip pop. The internal hip pop relates to the iliopsoas muscle. The iliopsoas muscle has shared attachments with the diaphragm. If the diaphragm is not providing a solid anchor point for the iliopsoas muscle, function of the hip flexor will be impaired increasing the likelihood of an internal hip pop. For this, focus working on diaphragmatic breathing to create better stability patterns in your core. Intra-articular hip popping requires an in-depth examination to determine which structures may be injured and to determine the best course of care.
To know exactly which exercises and treatments are best for you, it is important to seek out a therapist who understands hip biomechanics and can help you address the specific stability limitations causing the pop. Whatever the cause, popping in the hip should not be ignored. Even if caused by mild muscle imbalance, a popping hip can worsen over time if not addressed early.
Post written by Dr. Riley Kulm. Check out his bio here.
After a car accident your ‘to do list’ may be long – get your car fixed, find an attorney, file a claim with your insurance agent, find a rental car to get to and from work, etc. For most, the damages to your body are less of a concern in the initial stages following an accident. Unfortunately, many do not know where and how to find treatment for their injuries. Without the guidance of someone who understands the system, it’s possible to get taken advantage of as there are extensive legal businesses built around profiting from MVAs. In this post I’ll describe some of the most common injuries sustained during MVAs, as well as give you insight into the medico-legal process and how to make sure you get the care you deserve.
Opt into MedPay
In Colorado it is state law every insurance company provides their drivers with a minimum $5,000 Medical Payments Coverage (MedPay) policy in addition to their automobile liability policy¹. MedPay should be included on any insurance policy by default and is against state law for an insurance company to deny a customer MedPay. The $5,000 policy provides coverage for the driver, as well as the passengers in the insured driver’s car, regardless of which party is at fault. MedPay even covers you when you’re in a car that isn’t your own. Unlike other medical insurance, MedPay never carries a deductible or co-pay in the policy and is available immediately following the accident². Colorado MedPay covers payments related to bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of the motor vehicle. Colorado MedPay can be used to cover accident related expenses such as emergency or trauma care, ambulance rides, emergency room care, imaging services (X-rays, CT scans, or MRI’s), and conservative care treatments from chiropractors, massage therapists, and physical therapists.
Despite being mandated by Colorado state law, some insurance companies find ways to avoid providing their customers with the required $5,000 MedPay coverage. I’ve had numerous patients tell me they unknowingly opted out of their MedPay coverage before being told what the payment meant or included. Insurance companies in Colorado are required to include MedPay by default into any new policy, however, if you’ve opted out in the past, the insurance company is not required to remind you of MedPay or to ask if you want to opt in. If you use MedPay for an accident where you were not at fault your insurance company cannot raise your premium following the accident. I highly recommend calling your insurance agent today and making sure you have not opted out of MedPay. MedPay should be of little or no extra cost to your policy, and will provide you with much needed, immediately available funds following an accident.
Common injury patterns with MVAs
The injuries sustained in even minor MVAs can be severe. Many patients I’ve treated for a MVA report little to no pain the day of the accident, with symptoms hitting them hard the following morning. The shock involved with being in an accident is one explanation for the latency of symptoms, and oftentimes the brain is focused less on pain in the body and more on the financial and legal implications of the accident. Pain typically starts in the spine, with symptoms radiating down the extremities as the full effects of the injury are realized. I recommend waiting 2-3 days following a MVA to receive treatment. Waiting will ensure the treating physician gets the full picture of your injuries and can determine the appropriate treatment approach.
The most common type of injury sustained during a MVA is a whiplash type injury. Whiplash involves a sudden acceleration – deceleration force on the spine and muscles. Cervical acceleration – deceleration injuries are very common in MVAs and the whiplash injury causes tearing of muscle and ligament fibers. The muscles damaged in a cervical acceleration – deceleration injury are typically the cervical deep neck flexors which include the longus colli, longus capitis, and also the sternocleidomastoid. These muscles are extremely important for normal biomechanical function of the cervical spine. Weakness and inhibition of these muscles due to injury can lead to instability in the cervical spine and poor healing outcomes. Exercises targeting the function of these muscles are critical following a MVA and the guidance of a trained therapist is recommended to determine which exercises will be most beneficial.
Concussions are another possibility after a MVA and are most often associated with a blunt force trauma to the head against the steering wheel, dash, side window, or even an airbag. If the patient lost consciousness due to head trauma and post concussive symptoms are severe, a CT is recommended to rule out a more serious pathology such as an internal hemorrhage inside the brain. Any concussion, no matter how severe, deserves attention. Less severe cases warrant a neurologic examination by a trained therapist to assess for damage to the brain, spinal cord, or peripheral nerves. Some of the assessments used include a cranial nerve examination, ocular examination, and a high index neurologic exam that includes skin sensation, muscle testing, and deep tendon reflexes. The patient should also be taken through a verbal Sport Concussion Assessment Tool (SCAT 5) which helps determine severity of concussion and also to track treatment progress. Treatment of concussions often requires a nutritional component and an anti-inflammatory diet free of refined sugar and highly processed vegetable oils. High dose EPA/DHA from fish oil and vitamin D is also recommended to help heal brain tissue. Finally, our clinic uses a class 2 therapeutic infrared laser that can safely penetrate the skull and help to heal brain tissue via mitochondrial upregulation.
How long will it take to get better?
Tissue healing times are different for every patient and depend on age, injury history, genetics, nutrition, and lifestyle status. The severity of the accident and associated discrepancies in physical forces placed on the body are also a factor. As a general rule, the below gives the healing times for different tissue in the body which may be injured in a MVA³:
Muscle Strain (Grade 1): 0-2 wk
Muscle Strain (Grade 2): 4d-3mo
Muscle Strain (Grade 3): 3wk-6mo
Ligament Sprain (Grade 1): 0-3d
Ligament Sprain (Grade 2): 3wk-6mo
Ligament Sprain (Grade 3): 5wk-1yr
Many insurance companies try to fit every client into the same recovery timeline which is not realistic. If you are still in pain and someone handling your case says you need to be finished with care, advocate for yourself and demand the care you need.
At our clinic we use passive therapies such as acupuncture/dry needling, active release technique, therapeutic laser, cupping, and instrument assisted soft tissue manipulation among others to help you heal faster. We also use a wide variety of physical rehabilitation exercises to treat the specific deficits caused by the MVA. The focus of care after a MVA is to build strength, stability, and resilience in the cervical and lumbar spine and other body regions affected by the accident. Our goal is to make the patient stronger and more functional than they were before the accident.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Sources and References
The recent snowstorms in Denver are a reminder ski season is right around the corner. Skiing is an incredibly demanding sport requiring high levels of fitness and athleticism. As with any athletic endeavor, it is important to prepare your body for the forces and demands of the sport. A skier must have strong legs and hips so they can turn sharply on their edges, brace for impacts, and hike at high altitudes to reach the best terrain. Off season preparation drastically decreases your risk of injury and subsequent time away from the mountain, and is an integral part of every successful athlete’s program. I will provide 5 simple exercises you can do from home which will prepare your body to hit the slopes come winter.
The SAID Principle
Well accepted in the strength and conditioning world, the SAID Principle (Specific Adaptation to Imposed Demands) states training should be specific to the type of sport the athlete is preparing for. The intensity, volume, and duration of training should be tailored to the specific sport. Skiing requires a diverse mix of strength, balance, and endurance that is unparalleled in other sports. The athlete must be strong enough to dig their edges into the snow at high speeds, have the endurance to hike at altitudes above 10,000 feet, and have the balance and stability to correct body position when uneven surfaces are encountered or landing from a jump. The skier must build strong quads, hamstrings, and glutes to effectively and safely navigate the mountain. The program I outline below addresses each of these muscle groups with functional exercises specific to skiing.
Off-Season Ski Workout – perform the following sequence of exercises for 3 rounds.
Body Weight Reverse Lunge – 3 sets x 20 reps (10 each leg)
Body Weight Squat – 3 sets x 10 reps
Rear Foot Elevated Split Squat – 3 sets x 10 reps
Wall-Sit – 3 sets x 45 second hold
DNS 7 Month Side Lying Hip Get Up – 3 sets x 10 reps
I recommend performing this exercise routine 3-4 times per week. You can increase the number of rounds as you gain strength and endurance and as ski season gets closer.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
You’ve heard the stories, watched the YouTube videos, and maybe even experienced it yourself. The ‘pop’ or ‘crack’ made during a chiropractic adjustment is a mystery to most people. Are the bones cracking? The joints popping? The ligaments snapping? Where is the noise actually coming from? When a chiropractor delivers a high velocity, low amplitude thrust (HVLA) to a specific joint, there is often an audible sound associated with the adjustment. What is really causing this noise? Read on to find out more!
To understand where the noise in a chiropractic adjustment comes from, it’s important to first define the engineering phenomenon called ‘cavitation.’ Cavitation refers to air pockets or bubbles formed in response to a rapid change in the pressure of a liquid. Cavitation is often seen with underwater propellers, where bubbles are formed in response to the rapid change in water pressure caused by the spinning propeller. As pressure increases, these bubbles can burst, releasing a shockwave of energy. The field of engineering views the cavitation as a negative phenomenon to be avoided, because the energy released by the bursting bubbles can damage the propeller by subjecting it to uneven stress.
A joint is formed when two bones come together or ‘articulate.’ The surface of a bone comprising one half of a joint is called an articulating surface and is aligned with the articulating surface of another bone. Joints in the spine and extremities are referred to as synovial joints. There are several types of synovial joints in the body such as the ball-and-socket joint (hip joint, shoulder joint), hinge joint (elbow), and the pivot joint (between C1 and C2 vertebrae), among others. Despite having different shapes and planes of movement, all synovial joints share some common characteristics. Synovial joints are encased in a fibrous joint capsule called the articular capsule. Within the articular capsule is viscous liquid called synovial fluid. Synovial fluid is the consistency of egg-whites and its main purpose is to lubricate the joint, reducing friction and stress between the two surfaces of the joint. Healthy levels of synovial fluid help keep our joints moving freely and prevent the formation of arthritis.
Putting it all together
The phenomenon of cavitation is observed in the human body. When a chiropractor delivers an adjustment, the therapeutic goal is to gap or widen the two joint surfaces, resulting in a decrease in pressure within the joint capsule. The pressure decrease occurs within the synovial fluid, and bubbles are formed in response to this change in pressure. The bubbles rapidly collapse on themselves, releasing a shockwave of energy. The collapse of the bubbles and subsequent release of energy is believed to cause the audible pop or crack caused by the chiropractic adjustment. The noise made during a chiropractic adjustment is caused by the bursting of small bubbles within the synovial fluid of a joint in response to a rapid change in fluid pressure. Damage to the joint does not occur like it does to the propeller. The cavitation associated with the propeller takes place thousands of times per minute, whereas most patients get adjusted twice per week at the most. As such, regularly self adjusting your spine can lead to an array of negative outcomes. For more information, please reference my blog post, The Dangers of Self Adjusting. Lastly, to determine how frequently you should get adjusted, review my blog post, How Often Should I Get Adjusted?
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Patients often ask what the ideal treatment frequency is for getting adjusted. However, if you asked ten different chiropractors this question, you might get ten different answers. Within chiropractic, many different technique systems and schools of thought exist. Chiropractic treatments and treatment plans are not standardized within the profession and there is a high level of variability from doctor to doctor. With this in mind, the answer to how often you should get adjusted is it depends on your situation. Factors such as your age, health status, activity level, and diagnosis all factor into how often you need to be adjusted. For this post, I will address the question for someone who has mild or no symptoms and is looking to chiropractic for maintenance care and promoting overall health. To begin, I’ll describe the typical treatment plan for a new patient at our clinic.
Typical Treatment Plan
When a new patient comes to our clinic with a common complaint such as low back, neck, knee, shoulder, or elbow pain, we typically see them twice a week for 1-2 weeks, once a week for 3-4 weeks, and then reassess after 6-8 visits over 4-5 weeks. Adjustments will be performed at each visit. If the patient is markedly improved, we will push visits out 2-3 weeks and start seeing them on a less regular basis. Most patients feel substantial relief in just 2-3 visits, however, the underlying functional issues (posture, movement, breathing) causing the injury in the first place, take longer to reverse. Once the pain is gone and the patient is passing all of the functional tests relating to the original injury, we place the patient on a maintenance care plan where they come in once a month. The purpose of the maintenance care visit is to make sure the patient has not re-injured themselves or sustained any new injuries. We will also review exercises they have been prescribed in the past and check their spines to see if an adjustment is needed. At our clinic we use a mixture of chiropractic adjustments, physical therapy exercises, nutrition and supplements, and soft tissue therapies such as instrument assisted technique, active release technique, dry needling, laser, and acupuncture. By combining multiple therapies, we decrease healing times, allowing for a shorter and less costly treatment plan.
How often should a patient get adjusted for maintenance care and promotion of overall health? As stated previously, one chiropractor’s answer may differ from another’s, and our answer is based on the combined clinical experience of nearly a decade from the two doctors at Mile High Spine and Sport, Dr. Ryan Dunn and Dr. Riley Kulm. For maintenance care and promotion of overall health, we suggest patients come in for a full spine assessment and adjustment once per month. Maintenance care visits also include a functional movement exam to see if any limitations in muscle strength, stability, and range of motion exist predisposing the patient to future injuries. The purpose of the full spine assessment and functional movement exam is to identify issues before they surface to help prevent pain or injury. Similar to how it is necessary to go to the dentist every 6 months for a cleaning and exam, you should go to the chiropractor once per month to have your spine assessed for restricted joints and muscle imbalances to help prevent issues down the road. For quality preventative maintenance care, chiropractic is one of your best, and most cost effective treatment plan options.
Can I get adjusted more than once a month?
As a result of the numerous health benefits of getting adjusted, many of our patients decide to come in for adjustments more than once per month. Patients report improvements in breathing, energy, digestion, and sleep following their treatments. If you’d like to learn more about how the chiropractic adjustment can positively affect multiple areas of your health, please check out my post, Beyond Biomechanics: Exploring the Hormonal Benefits of the Chiropractic Adjustment.
From a safety perspective, it is entirely fine to get adjusted on a regular basis. However, I would not suggest getting adjusted more than three times per week as you run the risk of causing hypermobility in the joints. Hypermobility means the joints are moving too much and lack the muscular stability for normal motion and can lead to a variety of orthopedic issues. In general, we rarely see maintenance care patients more than once per week. We encourage patients to come in more than once per month if they find the benefits of regularly getting adjusted enhances their lifestyle and well-being.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
One of the questions I frequently ask my patients is whether or not they self adjust their spines. Self adjusting refers to cracking or popping your own joints by twisting and rotating your spine. Many patients answer yes to this question, and often say it is something they are unconsciously doing. Most people find temporary symptomatic relief when they self adjust their own necks or low backs, but what are some of the long term orthopedic consequences of self adjusting your spine?
What is self adjusting?
Self adjusting of the spine is when an individual twists or rotates their spine to a sufficient degree some of the joints in the area pop or what chiropractors refer to as ‘cavitate’. The ‘cavitation’ is essentially noise made by small bubbles popping within the synovial fluid of your joints and is completely safe. Individuals who self adjust may experience temporary relief with self adjusting because the mechanical stimulation of the joint popped momentarily blocks pain, tension, and tightness signals being sent to the brain. Muscles around the joint will temporarily relax as well. These all sound like positive outcomes, however, they are only temporary and typically last 5 to 10 minutes. The long term orthopedic consequences of self adjusting last much longer and are more damaging to your spinal health.
What is the problem with self adjusting?
The problem with self adjusting is when an individual adjusts their own spine, they lack the specificity to adjust the joints actually needing to be adjusted. Chiropractors are specifically trained to feel or ‘motion palpate’ joints and assess their ability to move in the directions they are designed to. Once a chiropractor identifies a joint is not moving properly or ‘restricted’, the chiropractor applies a high velocity low amplitude (HVLA) thrust to the specific joint in the direction it is not moving. Learning the skills of motion palpation and adjusting take years to master and should only be performed by trained professionals.
You are not adjusting the joints needing it the most when you self adjust. In fact, the joints popping are likely ones already moving too much! We call joints moving too much ‘hypermobile joints’ and these joints lack control of movement and muscular stability. Chiropractors identify ‘hypomobile joints’ or joints not moving enough, and adjust these joints to restore normal movement. The problem with adjusting the hypermobile joints with self adjustments is when you pop these joints you make them more hypermobile. Muscles surrounding a hypermobile joint have to work harder to stabilize the joint, and patterns of muscular pain, tension and tightness often arise. Additionally, adjusting hypermobile joints will make any adjacent hypomobile joints even more restricted. Over time, self adjusting will cause severe imbalances in the spine and decrease the spine’s ability to withstand the compressive forces of life and sport. The result is more serious conditions such as disc herniation, nerve compression, and severe instability among other serious spinal pathologies. Repetitive self adjustments in the neck can lead to chronic tension type headaches and migraines. In summary, adjusting your own spine will make the hypermobile or unstable joints move even more, and it will cause the hypomobile or restricted joints to be even tighter.
What should I do instead?
If there is an area of your spine feeling like it constantly needs to be adjusted, I would recommend consulting with a chiropractor trained in motion palpation and functional movement assessment. This individual can determine which areas of your spine need to be adjusted, and which areas need to be stabilized. In general, hypermobile joints are moving too much and need to be stabilized with a functional exercise focused on improving muscular control around the joint. Hypomobile joints need to be adjusted by a chiropractor in the specific direction of movement they are lacking. So remember, please think twice before the next time you are about to self adjust your neck or low back!
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Core Exercises – Do’s and Don’ts
Many patients understand they need to strengthen their core in order to live functional and pain free lives. However, most do not know where to start. The popular opinion is exercises such as sit-ups, crunches, bicycle crunches, and Russian twists are the primary exercises to improve core strength. Unfortunately, these commonly performed exercises are not the best choice when looking to add strength and functionality to your core.
The Problem with Sit-ups and Crunches
Sit-ups and crunches are perhaps the most regularly performed core exercises. These exercises are effective at increasing the tone of the six-pack or rectus abdominis muscle group. While great for aesthetics, a tight and toned six-pack is not essential for a functional core and may even be detrimental. The issue with sit-ups and crunches are the forces placed on the spine during these exercises. Both involve repetitive flexion of the lumbar spine and most of modern society already gets too much ‘lumbar flexion.’ Lumbar flexion means rounding forward of the low back. The low back is in flexion when we are sitting in our car, at work, or on the toilet. The low back is flexed when we pick items up from the floor with improper form. The net result of so much lumbar flexion is placing undue stress on the discs, muscles, ligaments, and nerves of the low back. Sit-ups and crunches involve repetitive flexion of the low back and thus add fuel to the ‘flexion fire’ we get all throughout the day.
The Problem with Rotational Core Exercises and Stretching
The Russian twist and bicycle crunches are other commonly performed core exercises that are not ideal for the function of the core or spine. The Russian twist is performed by balancing on your pelvis with legs suspended in the air and knees bent while the upper body is held at roughly a 45 degree angle. Next, the athlete uses their hands or a medicine ball to twist back and forth in an attempt to work the abdominal obliques. Bicycle crunches are similar except the individual is on their back and the rotational crunch is combined with a straightening of the opposite leg and hip. The first problem with the Russian twist is it is extremely difficult to keep the spine in a neutral position and many individuals round their backs due to a lack of core strength and balance. Once again, many people are developing a detrimental position of lumbar flexion during this exercise.
Another issue with the Russian twist and bicycle crunch is the forced rotational load it places on the spine. Functional movement specialists now agree the main purpose of the core is to resist forces placed against the spine rather than actually creating movement. The lumbar spine only rotates 2-3 degrees per segment and thus requires more stability in the rotational (transverse) plane compared to mobility. I’ll explain exercises such as the Pallof Press and Cross Press in a future blog post, as both are excellent exercises for improving core stability in the rotational plane.
Basics of Effectively Performing a Core Exercise
Before we get into the specific exercises I teach my patients, I’ll explain why form is important for any core exercise you perform. First, the spine needs to be in a neutral position. A neutral spine may look different for each person, but the spine should be straight and may have a slight extension curvature. Extension is the opposite of a flexed and rounded position of the spine. The two variables that affect proper neutral spine positioning are your rib positioning and your pelvic posture. Many patients have what is called ‘flared ribs’. This means your ribs are protruding upwards and forwards and may even be visible. When the ribs are in this position the diaphragm muscle cannot function properly and core strength will suffer. Use an exhale breath to push your ribs downwards towards the floor to place them in a more ideal position.
Secondly, you need to be aware of the position of your pelvis. Think about your pelvis as a fish bowl filled with water. If you have what we call an ‘anterior pelvic tilt’ your pelvis is dumped forward and water will be spilling out of the metaphorical fish bowl. Less commonly, patients may adopt a ‘posterior pelvic tilt’ where the water will be spilling backwards. Both of these pelvic postures are detrimental to neutral spine positioning, as well as core strength. Always think about keeping your pelvis tucked under you so water cannot spill out of the fish bowl. By making sure your ribs and pelvis work together to maintain a neutral spine, you will safely perform core exercises.
Practice these Core Exercises:
3 Position Plank
The 3 position plank is a sequential exercise involving a front plank, right side plank, and left side plank. Each position is held for 10 seconds before switching positions. Do your best to avoid dropping to the ground when switching positions. Switching positions every 10 seconds forces the brain and nervous system to react to a new stability pattern frequently and is thus more typical of how we move in life and sports. Additionally, by switching positions every 10 seconds we better guarantee perfectly executed reps.
The dead bug is another excellent option for building your core strength. Lay on your back with your hips, legs, and arms raised. Simply holding this position is a difficult exercise in itself and is an effective way to exercise your core. Make the movement more dynamic by reaching one arm over your head and slowly lowering the opposite heel towards the ground. Alternate sides, and perform in succession while making sure to keep your ribs down, low back glued to the ground, and head supported and slightly elevated to protect your neck.
The bird dog exercise teaches you to move your extremities while maintaining a neutral spine. The exercise does an excellent job of mimicking real athletic activities you will face in daily life. Get in a tabletop position with your hands stacked under your shoulders and your knees stacked under your hips. Your chin should be tucked and the back of your neck long with no creasing of the skin. Slowly move one of your arms forward while simultaneously extending the opposite leg backwards. The back leg only needs to be about 2 inches off of the ground to avoid hyper-extending your low back. Hold the completely extended position for a count of 2 and then return to neutral. Alternate sides while keeping a neutral spine and make sure to not let your pelvis rotate and shift excessively. Imagine there is a glass of water resting on the base of your low back and you do not want to let it spill!
My goal with this blog post is to provide you with safe and effective exercises for improving the strength and function of your core. Enjoy!
Post written by Dr. Riley Kulm, DC. Check out his bio here.