Movement is Medicine

 

Conventional wisdom in the past has been that all joints "wear out" at some point, so you probably shouldn't use them too much.  For example, I have had numerous patients tell me that their primary care physician has told them to stop running due to their knee arthritis. This is actually the opposite of what most recent research has shown.  We are now finding that sedentary joints become worse due to atrophy (disuse).  This is because the movement of the joint actually nourishes it.

The joints in the spinal column, hips and knees are synovial joints. The bones of a synovial joint are surrounded by a synovial capsule, which secretes synovial fluid to lubricate and nourish the joint while acting as a shock absorber. The ends of the joint bones are covered with smooth, glass-like hyaline cartilage which reduces friction during movement. So moving them is the best way to keep them nourished. 

In fact, in a 2018 study of marathon runners, LESS knee and hip arthritis was found in the runners when compared to the general population. ( The Journal of Bone and Joint Surgery: January 17, 2018 - Volume 100 - Issue 2 - p 131-137doi: 10.2106/JBJS.16.01071)

Not everyone needs to be a marathon runner.  But I believe that if someone wants to run for exercise, they should be able to. You may be asking yourself, "If moving the joint makes it healthier, why does it hurt when I move it?"  I would respond with "How can you be sure it's the joint that hurts?"  With literally dozens of muscle tendons, nerves and other soft tissues involved with a knee joint, how can you be sure it is "in the joint?"  The short answer is - you can't.  But now that we know it may not be the joint, it helps us get a bit closer to the truth.

Conveyor Belt Chiropractic

One thing I cannot understand is why any patient would continue to go to a chiropractor, or any clinician, who does not take the time to listen to you, the patient.  Or if that chiropractor does not modify the treatment plan when progress is not being made.  It has become apparent to me that some patients are impressed with the size and décor of these new chiropractic clinics. They conclude that the chiropractor must be good if the clinic is big and fancy.  But about once per week I get a new patient in my clinic because their previous chiropractor did not listen.  No time to talk, just adjustment, and out the door you go. Or maybe they did not take the time to address new problems. Or to make any significant improvement on the patient’s condition. It seems that some of the biggest, most impressive clinics are often made from an automation of the treatment process, not necessarily from patients’ success.  One patient described it as feeling like she was on a conveyor belt. “One size fits all and everyone gets the exact same treatment”.

There is no law to say that such a clinic is doing anything wrong.  But to keep doing the same thing (same adjustment, same, frequency, no exercises) and expect different results is the very definition of insanity.  Even some clinics that do prescribe exercises may be giving the exact same exercises for everyone.  "OK Mr. Smith, her is 'our exercise program'. Let us know if you have any questions."  And then you are on your own to try to make sense of them. Is it likely that everyone has the same condition for the same reasons, requiring the same exercises? Was there any protocol to see if those exercises were actually needed? You feel as if you are on and off the conveyor belt before you are even able to ask any relevant questions. 

Ultimately I feel as though finding the path to success is often like a recipe.  My first chiropractic treatment is equivalent to the first time I make the dish. And how the patient feels when they come back tells me how tasty the dish was.  Sometimes the recipe is perfect and patient feels great after one visit.  But oftentimes the patient feels about the same, or is somewhat unsure of any progress after one treatment. Then it's time to tweak that recipe. Maybe it's missing an ingredient like a stretching exercise for a tight muscle? Or maybe manual therapy or massage therapy should be added to boost the overall flavor? Or maybe we need to review the patient's computer workstation ergonomics for a little extra spice.

How a new chiropractic patient feels on their first visit should not dictate the treatment forever.  Ongoing reassessment is essential.  Listening to the patient is just as much a science and an art as is the chiropractic treatment.  People skills are as important as adjusting skills.  And improving patient outcomes is more important than having the biggest and fanciest clinic in town. 

So the question is...is it time you got off the conveyor belt? 

Pound pressure : painful weight

I sometimes get patients who believe that their painful conditions are brought on, at least partly, by their excessive bodyweight. They are not wrong, but what I sense is that many of these patients are frustrated. They are frustrated because they are aware that their excessive bodyweight is a factor in their pain, yet they have put their overall health on the proverbial back-burner. Life has a way of making us feel overloaded to the point where don’t feel like we have the time or effort to improve our own health. Yet if we don’t, our ability to get through each day diminishes due to pain and fatigue. 

So when patients ask me specific questions on diet, I am happy to give them the best information I have. While I am not a dietician, it seems to me that most people need to focus on eating real food, and less processed foods. Yes, quantity is often part of the problem, but I doubt that any of my patients are overweight because they eat too much raw broccoli. Plus, avoiding processed foods leads to less overall inflammation in your body, which can improve both pain levels and mobility. Studies confirm that when we overeat, it is usually on easily digested highly processed foods. So while caloric restriction, or fat reduction, or carbohydrate elimination may each work for some people, focusing more on the wonderful REAL foods that you can eat, is a much more positive approach. 

Overall, I feel that sometimes too much emphasis is put on the number that pops up when we step on the scale. Healthy people come in many shapes and sizes. Bodyweight is one measurement of health, but is it really the most important? If all your blood tests and biometrics like blood pressure and heart rate are within normal limits, what does it really mean? After all, I myself have been technically clinically obese most of my adult life. At 5’9” and over 205 lbs., I have completed a marathon, a sprint triathlon, and a cyclocross race. Currently I am also doing cross country skiing, and indoor rock climbing. I passed my last medical checkup with flying colors.  Some would say its probably muscle, and not fat, but the clinical guidelines for bodyweight don't take that into consideration.

So what is the secret to my success? Don’t stop moving! And don’t stop trying new activities. That being said, if you have not exercised for years, don’t assume that you can pick up where you left off. If the last time you ran for exercise was in college, you will be in for a rude awakening if you try to match your performance from decades ago.  What is the best type of exercise you ask? It’s the one you will do the most consistently. So what is the exercise that you love the most? (Or maybe hate the least?)

Please consider developing habits based on what is healthy, rather than what will shed pounds. Given long enough, healthy habits will usually lead to weight loss.  And if you don't feel beautiful as you are right now, just remember that healthy people ARE ALWAYS beautiful. Beautiful people, just like healthy people, can come in all shapes and sizes. I have seen many people try some questionable methods to lose weight. sometimes it is obvious that their methods are truly unhealthy. Unhealthy and unsustainable weight loss will always lead to rebound weight gain.

Now, think of all the people that you love. Everyone in your life that you truly love. Do they all have “perfect bodies”? Probably not. Do you love them any less because they don’t? Probably not. If the people in your life can love you as you are, YOU CAN TOO! The first and most important step is to love yourself. Love your body. Love it enough to respect it. Love it enough to accept it the way it is right now, at this moment. That is the ONLY way ANY new healthy habits can start. 

Try this quick and easy stretch to cure your low back pain

       Sorry, there is no quick and easy stretch to cure your back pain. 

(Stop falling for click-bait!)  

      Why shouldn't you believe random people on social media?

It is because there are so many possible reasons why someone might have low back pain. There is absolutely no way there could be one solution for everyone.

Here is a list of some of the more common reasons for low back pain:

-too inactive/sedentary

-poor posture

-poor sleeping position

-muscle tightness due to being in one position too long

-muscle weakness due to not finding enough variety of movement or exercise

-overuse due to work 

-overuse due to exercise training error

-overuse due to recreational sports/hobbies

-traumatic accident

-slip and fall

-previous injury to foot

-previous injury to knee

You may notice that I did not mention things like intervertebral disc herniations or sciatica.  That is because these are classifications of low back pain, and not reasons.  One could have an L5 disc herniation due to being too sedentary, or due to overuse lifting/bending, or due to traumatic accident, or all of the above. If you have seen your physician about your low back pain, and have only been told a diagnosis, but not a reason, it might be time for a second opinion.

And stop falling for "quick and easy" solutions.  Find out why you hurt. (616) 301-3000.

What is your 2022 Fitness Plan?

Tis the season!

 Yes it is certainly the season for holiday celebrations, overeating, and family gatherings.  But it is also the season to plan for the next season -  New year's resolutions!

"So...what kind of exercise routine can you see yourself doing next year?"

I find that it helps if I put a seed in the patient's head. So that when the new year comes, they will already have a plan, and only need to execute.  If you fail to plan, then you plan to fail!

I don't expect everyone will do it. But I can attest that my patients that do exercise regularly have lesser pain overall once they get into a regular routine.  

I also don't expect that everyone will have access to a gym or health club.  But maybe that's not necessary. Some people love the outdoors in winter.  Maybe cross country skiing? Winter bicycling? Snow shoeing?  If you don't like the cold, there are still indoor malls you can walk. Most folks below the age of 60 should have loftier goals than just walking, but it can be a good part of a combination of exercises.  And starting with something small is way better than nothing at all.

Home gyms, treadmills, and spin bikes can all help to reduce the time needed to travel to a gym. But joining a new gym or health club really is the best way to get maximum variety if finances are not restrictive. 

There is also no shortage of exercise videos online.  Some are by subscription only, but there are plenty of good free ones.  I even posted some of my own on our Youtube page.  

https://www.youtube.com/channel/UCIc9cdNSrfxbF9h3lWOoMRw

 

Lastly, the latest technological gadgets that monitor your steps, heart rate, etc., are really good at tracking progress.   But truthfully they are often unnecessary.  Don't put off exercise because you don't have one,  or tell yourself  you can't start because the store ran out of Fitbits.  People have been exercising for a long time before these fitness devices became available. Who knows? If you have been good this year, maybe Santa will bring you one.

Cuboid Syndrome : pain on the outside part of the foot

What is cuboid syndrome?

Symptoms: Pain on the lateral (outside) part of the foot.  There is often no associated accident or injury to this area, though sometimes twisting one's ankle can exacerbate it.  Often it develops slowly and for no apparent reason.  It will usually feel worse when standing on the affected foot. Walking is also usually painful.  Wearing shoes that are tight around the forefoot can become unpleasant. 

Cause: It is theorized that the syndrome occurs when the foot pronates excessively, causing a misalignment of the cuboid bone.  Personal experience suggests that this is partly true. My most observation is that most commonly the affected side is the foot that is too far midline.  People rarely stand perfectly symmetrical.  Usually one foot is more medial. Or to say it another way, is that the foot is more underneath you. This usually results in excessive pronation, as well as more forces being absorbed by the affected foot in standing, walking and running.  Athletic activity increases one's chances of  getting cuboid syndrome. 

Diagnosis: Examination may reveal some swelling.  Cuboid pain and tenderness to palpation is typical. X-rays will often show nothing, as alignment is not always discernable.  Absence of fracture is a good indication. Whereas misalignment is the primary pain mechanism, radiological imaging is not often necessary for diagnosis. Considering the cost of soft tissue imaging techniques like MRI and CT scans, it makes more sense to attempt therapy before even considering these expensive options. 

Treatment: manual manipulation is extremely effective when performed by a skilled professional. Multiple treatments is usually necessary.  Total number of treatments is dependent upon how long the patient has had cuboid syndrome. 

Dr. Schafer's note:  As I previously stated, cuboid syndrome is usually due to asymmetrical stance and gait. When one foot is more medial (midline), not only is the foot misaligned, but so is the knee, hip, pelvis and spine.  Long term success depends on re-alignment of the whole system.  Chiropractic manual adjustments techniques are extremely helpful, as well as core exercises. Yes-core exercises are better than foot exercises for long term success. 

Does everyone need a chiropractor?

While on a recent vacation to Ireland, we toured the Guinness factory in Dublin.  Near the end of the tour there was lots of old Guinness advertisements, and some artwork from local artists. I found one piece of art both striking and thought provoking: "A woman needs a man like a fish needs a bicycle".  Apparently it was a phrase found in graffiti on the streets of Dublin, and a local artist liked it so much he made it into this display.  The phrase is also used in a song by the (Irish) band U2 in the song "Tryin' to throw your arms around the world". I am sure there a some women who would agree with this, and some who would disagree. But I think the main point is that for some fish, uhm, I mean women, this is certainly true. There is no universal truth one way or the other. 

This made me wonder.  Does everyone need a chiropractor? Is it a universal truth that everyone needs to be adjusted on a scheduled basis all of the time?  I know there are plenty of chiropractors that will respond with an emphatic "yes!" But to say that (as a universal truth) would ignore the millions of people who have never been to a chiropractor, and seem to be in good health regardless. This does NOT MEAN NO ONE needs a chiropractor.  I have seen too many patients who were treated poorly by the medical system, or have tried every physical therapy exercise known to man, or have ignored the pain for years with opioids which they can no longer take.  And without regularly scheduled adjustments, their pain would quickly overwhelm them to the point of debilitation.  Some of these patients have had significant trauma for which there is no surgical "fix".  And some of them just have a genetic predisposition for musculoskeletal pain. Many of them have jobs which keep them sedentary, and this alone is the biggest contributing factor for their painful syndromes. 

 If you have a chiropractor that keeps you out of pain, by all means, continue treatment.  If you only need to be adjusted by a chiropractor periodically, that's great! Get treated "as needed".  When a new patient walks into my clinic, my goal is to figure out why they are hurting, not to figure out how to make them a patient for life.  I am not in the business of trying to convince a fish that they need to be riding a bike. But if you ask me this fish looks she wants to.