Last weekend I had the pleasure of attending the annual Colorado Chiropractic Association (CCA) Conference. Each year chiropractors from across Colorado gather to enjoy a weekend of educational speakers, networking, and discussion of the future of the chiropractic profession in Colorado. The CCA conference offers a unique opportunity for doctors of differing experience levels, techniques, and chiropractic universities to connect with a common goal – the advancement of the chiropractic profession in Colorado.
Since there has been a scarcity of in-person continuing education opportunities over the last two years, the phenomenal speakers at this year’s conference were a breath of fresh air for the doctors in attendance. As a clinician, it’s important to regularly learn new treatments and methodologies, staying up to date with the most current research available. I truly love continuing education courses because you come back to work with a renewed sense of vigor, and are eager to try new treatments and methods to help your patients. There were many fantastic speakers at this year’s conference, including Dr. Mike Hall, DC, Dr. Alicia Yochum DC, and Del Bigtree.
Dr. Hall spoke extensively on the importance of maintaining a healthy cervical lordosis. The cervical lordosis is the natural C-shaped curvature your neck should display. Many patients present with a flattened cervical spine which may be due to prior motor vehicle accident (MVA), prolonged poor posture, or genetic predisposition. Dr. Hall spoke about how the cervical lordosis acts as an indicator of the orthopedic health and fitness of the rest of the body. Patients with good strength in their hips and legs, shoulders and arms, often present with a healthy cervical lordosis. Conversely, individuals with poor strength in the lower body and who sit at a computer all day, often have a flattening of the cervical curve. Patients dealing with chronic stress and anxiety often present with head tilts and a poor cervical curve, indicating that the emotional and physical health of the brain is represented in the health of the cervical curve. The cervical curve is a window into the neurologic and orthopedic health of the entire body.
Dr. Alicia Yochum, daughter of Terry Yochum, who is co-author of Essentials of Skeletal Radiology, a textbook universally used in chiropractic and medical radiology programs, spoke about clinical radiology cases. For each case, she asked the audience to identify the pathology and then decide the appropriate course of action in terms of treatment or external referral. Dr. Yochum also spoke extensively on the benefits of musculoskeletal (MSK) ultrasound which is a cost effective diagnostic tool for soft tissue injuries. She provided an excellent review of how to distinguish T1, T2, and STIR sequence MRI’s. As a talented presenter, she made her radiology course engaging for all attendees.
To round out an exceptional group of speakers was Del Bigtree, former Hollywood producer of ABC’s The Doctors, who now uses his production skills to educate the public on the danger of vaccines, medical misinformation, and the pursuit of health care freedom in the US. His highly acclaimed internet show, The Highwire, is watched by millions of Americans who seek unbiased information when it comes to health related topics in the US. Bigtree spoke at length on the dangers of global vaccination for Sars-cov-2, which has a 0.26% mortality rate worldwide. Noting Dr. Robert Malone, inventor of mRNA vaccines, has even publicly spoken out about the dangers of global vaccination and has urged the medical community to stop. The mRNA vaccines use a new form of technology where vaccine adjuvants can turn off the ‘toll like receptors (TLR’s) of the patient’s innate immune system. Turning off the TLR’s allow the mRNA gene therapy to quickly bypass the innate immune system and enter the patient’s cells with the goal of stimulating an immune response and subsequent antibody formation. The overlooked issue is TLR’s are an extremely vital component of our immune system and shutting them off may have deleterious effects. Bigtree noted many oncologists have contacted him saying they’ve never seen new cancer rates this high in the US, and one plausible explanation is widespread vaccination with the mRNA gene therapies. Bigtree is a prominent advocate for the health freedoms of all Americans and I am grateful to have heard him speak on such a divisive and important topic.
The 2021 conference was my second CCA conference and I left feeling refreshed, excited about chiropractic, and with a wealth of new information to share with my patients. Whether you’ve been in practice for 3 years or 30, chiropractors share a kinship with each other and treat each other with respect. I enjoyed getting to know other Colorado chiropractors such as Dr. Roman, Dr. Pearson, Dr. Starling, and Dr. Birdsall just to name a few. My deepest thanks goes out to the staff of the CCA and all those involved in orchestrating a truly fantastic weekend.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
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
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.
Dry Needling
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.
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!
Cavitation
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.
Synovial Joints
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.
Maintenance Care
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.
Over the past weekend, Dr. Ryan and I had the pleasure of attending the annual Colorado Chiropractic Association (CCA) convention. Speakers from all around the country discussed the benefits of receiving chiropractic, specifically the hormonal benefits of receiving regular chiropractic adjustments. Chiropractic adjustments have a beneficial effect on your endocrine (hormonal) system, resulting in far reaching health benefits you may not previously have associated with the chiropractic adjustment.
The topics covered in this blog post are inspired by two lectures given at the 2019 Colorado Chiropractic Association (CCA) convention. The first is a lecture given by Dr. John Minardi, DC on 10/26/2019 and was titled ‘The Power of Chiropractic.’ The second is a lecture given by Dr. Monique Andrews, MS, DC, DNM on 10/25/2019 and was titled ‘A Potential Role for Chiropractic in the Neurobiology of Autism.’
How chiropractic adjustments affect your brain.
First, it’s important to explain that the chiropractic adjustment does not only affect the joints of the spine and extremities, but also the brain. When a joint is adjusted, special nerve receptors embedded in the joint capsule called mechanoreceptors are activated and fire signals to the brain. These signals are received and integrated by the brain, and the brain’s activity is noticeably changed in response to the sensory input from the adjustment. Studies have shown increased glucose uptake (a marker for metabolic brain tissue activity) in the frontal lobe of the brain following an adjustment (Inima et al, 2017). The frontal lobe of the brain is responsible for executive functions such as decision making, personality and emotional expression, problem solving, and also controls our ability to communicate and connect with others. This may explain why chiropractic is an excellent, yet underutilized, adjunct therapy for children dealing with autism.
When an adjustment is performed and mechanics in the spine improve, signals are sent to the brain conveying the new, corrected position and/ or motion of the vertebrae in the spine. The brain accepts and integrates these signals, producing an output signal that will have far reaching effects in the body. When joints are aligned and moving properly in the spine, the brain produces signals to the body that promote health and decrease inflammation. When joints are not aligned and are not moving properly, the brain produces signals that decrease health and increase inflammation.
How the brain functions after an adjustment.
Now that we know adjustments affect the brain, let’s talk about the positive changes that occur in the brain after an adjustment. The hypothalamus is a small region located at the base of the brain near the pituitary gland. The hypothalamus is important for the regulation of body temperature and other homeostatic systems such as hunger, thirst, sleep, and circadian rhythm. The most important role of the hypothalamus is the linkage of the neurologic system to the hormonal or ‘endocrine’ system via the pituitary gland. The hypothalamus receives sensory information from the body, and produces ‘neurohormones’ that activate or inhibit the release of hormones from the pituitary gland. When we adjust the spine we improve the quality of sensory information that is sent to the hypothalamus. Here is where the magic happens. As I previously described, when you are adjusted, small nerve endings in the joints called mechanoreceptors are activated and send signals to the brain. These signals provide your brain with valuable information about where the body lies in space, the structure and integrity of your spinal column, and can even block or mask pain signals being sent to the brain by other sensory nerve endings! Adjustments positively affect the brain and nervous system, improving the quality of sensory information sent to the hypothalamus. The end result is an improvement in the quality of hormonal release that is governed by the hypothalamus.
How the brain functions when things are off-balance.
Spinal malposition and/ or decreased joint range of motion is perceived as a stressor by the brain. The brain sits on top of the spine and thus relies on the spine for its structural stability. Imagine you were trying to replace a light bulb, but did not have a ladder. You need to get the job done, so you decide to stack boxes on each other for you to climb until you can reach the light bulb. After stacking the boxes, imagine that one of these boxes is rotated and has slid out of alignment compared to the other boxes. How confident do you feel about climbing the boxes to change the light bulb now? I’m guessing you’d be a little more nervous and stressed standing at the top of the boxes. In this metaphor, the boxes are your spinal vertebrae and the person standing on top of the boxes is your brain! If the boxes are not in proper alignment, you will perceive standing on top of the boxes as danger and your stress hormones will dominate. The body acts in the same way. When the brain does not sense healthy alignment of your spine, poor information is sent to the brain and stress hormones are released.
When the brain is stressed, hormones such as cortisol and norepinephrine dominate. These are the hormones released in the body’s ‘fight or flight’ response and are very useful in situations where the body needs to respond to a threat to survival. These hormones increase heart rate and breathing, shunt blood to the heart and skeletal muscles and away from the digestive and reproductive organs, dilate the pupils, and cause metabolic changes that increase energy delivery to skeletal muscles. The problem is that in modern society many individuals are in a chronic state of stress, and thus their ‘fight or flight’ system is always on. Hormones such as cortisol and norepinephrine are essential to life, however the constant presence of them in our bloodstream due to a stressed state is highly damaging. Improper cortisol release timing is one of the main implications for weight gain and an inability to control cravings for sugar and highly processed foods.
Testosterone and Estrogen.
By decreasing the stress response to the brain, adjustments decrease the amount of cortisol released by the adrenal cortex via the pituitary gland. Inappropriate cortisol release wreaks havoc on the endocrine system. Hormones such as testosterone, estrogen, dopamine, and serotonin are all measured at lower levels when cortisol is too high. Testosterone is often singled out as important for male sex drive and energy, and while this is true, research also suggests that men with higher levels of testosterone show more compassion and are more loving to their partners. When cortisol levels are high, testosterone levels plummet. Estrogen is highly important for bone formation in women and also for achieving and maintaining pregnancy. Cortisol kills off estrogen and progesterone, another important hormone for maintaining pregnancy.
Dopamine and Serotonin.
Dopamine is our anticipation hormone. It governs the motivational component of reward-motivated behavior. Dopamine fuels the anticipation of a future reward. Dopamine is released when we are particularly excited for an upcoming event, i.e. seeing a loved one, going on a long anticipated vacation, etc. Dopamine is also released when we are particularly anxious for an upcoming event. Proper cortisol and norepinephrine levels are necessary to maintain balance in the dopamine system. When cortisol and norepinephrine are high, due to stress on the brain, dopamine release goes awry and can cause depression, thrill seeking, unhappiness, decreased immune function, excessive worrying and bickering.
Serotonin is the body’s satisfaction hormone. It governs happiness, satisfaction, and fulfillment in life. Serotonin is even boosted when in the presence of a particularly friendly or happy person. Excessive cortisol decreases the amount of serotonin and can contribute to depression and chronic pain syndromes such as fibromyalgia.
Excessive cortisol and norepinephrine throw the entire endocrine system out of whack. Cortisol will decrease sex defining hormones such as testosterone and estrogen, dampen the effect of dopamine, our motivation-reward hormone, and serotonin, our happiness hormone. The good news? Chiropractic adjustments and other forms of manual therapies decrease the amount of cortisol and epinephrine released by the adrenal cortex and medulla via the brain and thus increases the levels of all these highly necessary and beneficial hormones. As a result, many of my patients report improvements in breathing, energy, digestion, and sleep following a chiropractic adjustment. Even if you are not in pain, regular chiropractic adjustments are highly beneficial for your health and should be received at least once monthly. By getting assessed at least once a month you are ensuring the health of the joints in your spine and extremities, and drastically decrease the risk of future injuries, and the need for costly orthopedic surgeries.
Post written by Dr. Riley Kulm, DC MS. Check out his bio here.
Citations: Evid Based Complement Alternat Med. 2017;2017:4345703. doi: 10.1155/2017/4345703. Epub 2017 Jan 12.