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Chiropractic Questions and Chiropractor Answers

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CHIROPRACTIC QUESTIONS ANSWERSChiropractic Questions and Chiropractor Answers

Question #25 

Lower back pains !!!? 

I work an eight hour shift almost every day and stand on my feet constantly. My work duties require me lifting heavy objects. I always try to lift with my legs and not my back. However, lately the lower right side of my back has been killing me. It is very painful to sit, so I stand more or lay down when I get the chance. What can I do to lessen the pain?

Answer: 

From my professional standpoint it appears that you might have an overuse or repetitive soft tissue injury. That might involve sprained tendons and strained musculature around the lumbar spine. Also herniated disc and subluxated lumbar vertebral level can also be contributing factors for the pain. I would suggest that you take some time off of work and see your local chiropractor who has physical therapy equipment and massage therapist in the office. The time off of work will allow your body to avoid farther soft tissue damage and proper rehabilitation will expedite the healing process. Hope it answered your question

 

Question #26 

What’s wrong with my ankle(s)? 

Last year during volleyball practice, I dove and twisted my ankle. Ever since it has been weird. I’ve had really flat feet since I was a little kid, and my ankles always hurt because of that. i don’t wear very supportive shoes, but even when I do it doesn’t help. I went to a podiatrist a few months ago, and he diagnosed me with an excessively flexible flat foot. Strange. I use an ace bandage on my ankle, but to no avail. Nothing has made it feel better. It hurts off and on, though, and when it hurts it hurts a lot. I think I sprained it that day, and since I have bad feet, it just never healed. Do you think that’d what happened? Also, do you recommend for me to get those sport supports you put on your ankles with your shoes while playing? Thanks in advance. Also, I’m kind of an injury magnet 😀 never broken anything, but I always seem to be hurting myself

Answer: 

You are correct about sprain injury to your ankle. When this happens the soft tissue needs a proper rehabilitation in order to prevent scar tissue formation. Most likely you did not have any rehabilitation at all thus is the reason for the pain. At this point it is in chronic stage and will require some time to fix it. Deep tissue massage and active/passive ROM will help. As to your second question about ankle support – you can use it if it does not interfere with your game and running pattern. The most important thing is keeping your gate normal.

 

Question #27

Tingling in my left leg, please help?

 

It started with lower back problem where i could sit down for a period of time, couldnt bend over or put on my socks. This happened overnight. This lasted for 5 months then I woke up with tingling and pain on my left butt cheek all the way down my leg. All of this has lasted for 8 months now and wont go away. Have been through 3 X-rays, and 3 Physical Therapist and nothing. They refuse to give me an MRI. They keep saying it’s a weak core but I know it’s not because I can do advanced core exercises with not problem. I believe my muscle is pinching my sciatic nerve. Can someone please shed some light on this for me?

Answer:

X-Rays will not show soft tissue problem. What you need is an MRI, but it looks like your ignorant doctors refuse to authorize it. Sounds like a Kaiser type of therapy. Physical therapy will not help either at this point and time as strengthening injured musculature and soft tissue is only going to make things worse. Get a second opinion about your problem. I am afraid if you are attached to a particular treatment facility your only option would be paying out of your own pocket and figure out what is going on. I think finding a local neurologist or a chiropractor would be my first step. It all depends on what kind of treatment you would prefer for this kind of problem. It could be Sciatica but it could also be Sacroilliac Joint misalignment.

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Soft Tissue Injury and Fibroblast Regeneration

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FIBROBLAST AND SOFT TISSUE REPAIR

Soft Tissue Injury and Fibroblast Regeneration

Mechanical friction during deep tissue massage, fascial manipulation or using techniques like Graston will activate the stimulation the fibroblast reproduction after soft tissue injury. These fibroblasts cells are the most common cells of connective tissue, and they synthesize the extracellular  matrix (ECM) and collagen, which is the main framework of our soft tissues. The properties of the connective tissues depends on the composition of ECM – tendons, ligaments and other connective tissues. Elastic and reticular fibers, glycoproteins, glycosaminoglycans, and collagen are all found in ECM and made by fibroblasts.  Collagen is the most important part of ECM and plays very important role in tensile loading. The stimulation of production of the above mentioned components can be achieved by frictioning tissues (in other words by providing cross-fiber massage).

Fibroblast production and degeneration is a normal process in every day mechanical loading such as walking, running, bicycling or any other form of movement. There are four basic types of loads: tension (tensile force-fibroblasts), compression (chondrocytes), fluid shear (vascular endothelial cells) and torsional shear. Collagen synthesis in patellar tendon ( which is used the most by bicyclist and runners) increases by nearly 100% as a result of just single bout of acute exercise, and the effect is till evident three days later. I guess I am doing a good job with my knees by keeping them busy with prolonged Mountain Bike Riding and avoiding soft tissue injury.

In the beginning of a training period the balance between synthesis and degradation is increased and there is a net loss of collagen. This enables a tendon to restructure and adapt to an increased loading pattern. It is not till training progress that there is a net gain in collagen synthesis. Deep friction massage can also help to repair a mild soft tissue injury to a knee tendon. Fibroblasts play an important role in wound healing. When connective tissue and blood vessels get injured, growth factors cause fibroblasts to enter the wound area, increase its numbers and begin synthesizing new collagen fibers, creating new granulation tissue and assisting in remodeling. The ECM of granulation tissue is created and modified by fibroblasts.

Recently I was exploring a new trail with another rider. During a steep rocky climb my rear wheel lost a traction and my right knee got over extended. I felt sharp pain but continued on riding. Next day I felt sharp pain around and under my right knee cap (patella tendon). Three to four sessions of deep tissue massage, cross friction massage and modalities such as electric stimulation and Erchonia Cold Laser L5000 model made my knee completely pain free. This is a real example of how Fabroblast is working.

There has also been research done that eccentric exercises may provide more benefit than concentric exercises regarding rehabilitation of muscles and tendons. Eccentric exercises provide greater stimulation of fibroblasts, increasing collagen synthesis and therefore stimulating the healing of soft tissue.

 

Chiropractic Rehabilitation and 4 Stages of Soft Tissue Healing

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The healing process is divided into four broad stages which are not mutually exclusive and overlap considerably.

1. Initial vascular reaction – Active Swelling

2. Inflammatory response – Passive Congestion

3. Proliferative phase – Repair

4. Remodeling 

Wound healing refers to the body’s replacement of destroyed tissue by living tissue (Walter & Israel 1987). It comprises of two essential components whose differentiation is based on resultant tissue: Regeneration and Repair.

TISSUE INJURY CAUSES RESTRICTION OF MOTION DUE TO:

  1. Inflammation & Swelling
  2. Pain
  3. Muscle Spasm 

THE MAJOR GOALS OF CHIROPRACTIC CARE:

  1. Relieve Pain
  2. Promote Full Healing
  3. Restore & Maintain Full Function
  4. Reduce the Likelihood of Re-Injury
  5. Prevent Accelerated Degeneration 

Chiropractic Care Should Continue Throughout the Repair Stage. It Take Longer For Tissues to Heal & Normal Function to be Restored Than it Takes for Pain Relief. Pain Relief is not the Only Goal.  Chiropractic Helps:

  1. Restore Normal Motion, Function & Biomechanics
  2. Improve Alignment of New Connective Tissue
  3. Prevent Shortening of Scar Tissue & Chronic Stiffness
  4. Restore & Maintain Flexibility of Ligaments & Muscles
  5.  Restore Normal Muscle Tone
  6. Promote Quicker, More Effective Healing
  7. Restore & Maintain Normal Sensation
  8. Reduce the Risk of Re-Injury and Degeneration 

STAGES OF SOFT TISSUE HEALING

 

STAGE I: ACTIVE SWELLING

  1. Swelling Occurs for 12 to 72 hours
  2. Motion is lost and pain increases 

Goals of Care: Minimize pain and swelling

Care:

  1. Rest & Support of Injured Area
  2. Ice to Block Swelling, Pain, and Spasm 

STAGE II: PASSIVE CONGESTION   

Fluid trapped in tissues restricts motion, causes pain, & delays healing. Begins by second to fourth day

Goals of Care for Passive Congestion:

  1. Remove fluid
  2. Pain Relief
  3. Begin to restore range of motion 

Care:

  1. Chiropractic Adjustments Help
  • restore motion
  • block pain
  • restore normal sensation
  • relax tight muscles
  • remove swelling
  • accelerate healing
  1. Heat and Cold to Remove Fluid
  2. Controlled Motion Exercises
  3. Physical Therapy helps in Some Cases
  4. Acupuncture Can Help With Pain Control 

STAGE III: REPAIR

Beginning 5 days after injury, scar tissue is made for up to 6 weeks. 

Lack of motion causes excess scar tissue in dense patterns disrupting normal function causing:

  1. Excess Scarring
  2. Chronic Stiffness
  3. Limited Range of Motion
  4. Poor Biomechanics
  5. Chronic Pain
  6. Weak Muscles & Ligaments
  7. Loss of Normal Sensation
  8. Poor Nutrition
  9. Increased risk of Re-Injury
  10. Accelerated Degeneration 

If Motion is Restored & Maintained, Tissues Heal in a Much More Functional Way.

Coals of Repair Stage:

  1. Restore Normal Range of Motion
  2. Restore Sensation
  3. Promote Full Healing
  4. Relieve Pain 

STAGE IV: REMODELING 

Connective tissue remodels for better strength & flexibility. This often takes 3 to 14 week but may take up to 1 year with severe injury. 

Chiropractic Helps Achieve these Goals:

  1. Improve & Maintain Motion & Flexibility
  2. Restore & Maintain Function
  3. Reduce Chronic Pain
  4. Reduce Risk of Re-Injury & Degeneration

This Post was based on Dr. Malik Slosberg’s Research.