structural issues, chiropractic, subluxation, intervertebral disk, slipped rib, chest pain, shoulder pain, back pain

Structural Issues

Structural Issues

The human body is incredibly complex. It is structural, meaning that it has substance. If I lean on someone I meet resistance; I am supported. My hand does not pass through them as through a vapor. The body is biochemical, as evidenced by the many substances that can be detected through blood tests. The body is electrical. The electrical activity of the heart can be recorded as an electrocardiogram, the electrical activity of the brain as an electroencephalogram, and the electrical activity of muscles is seen on an electromyelogram. The magnetic character of the body is viewed through magnetic resonance imaging (MRI).

My medical training placed a great deal of emphasis upon the biochemical body. I was taught which blood tests to order and how to interpret them. I was taught pharmacology, the science of using chemicals to treat various illnesses. Amazingly, I was taught almost nothing about supporting the body’s biochemical processes with vitamins, minerals, fatty acids, or other nutrients.

I was taught to use electrical tracings to diagnose disease, and I learned how to use an electrical shock to restart a heart that had stopped beating, or to restore a regular rhythm in a heart that was beating irregularly. I was taught the indications for use of electroconvulsive shock therapy for mental illness. As was the case of the biochemical body, however, I learned nothing about supporting the body’s electromagnetic activities.

Major structural damage was addressed. I learned how to align fractured bones, the proper techniques for replacing dislocated joints, and how to deal with ligaments that had been sprained. I learned nothing, however, about maintaining the structural integrity of the body. I did not know that joints in the spine could become locked, that a vertebra could rotate out of position, or than a rib could be slightly displaced and unable to move smoothly. Since I did not know such problems existed I was unable to recognize or correct them.

My awareness and understanding of subtle structural abnormalities began approximately fifteen years ago when I faced a personal challenge. One afternoon I noticed that my right shoulder was sick. I was puzzled, because I did not remember injuring it. The symptoms I experienced were vague and hard to describe. One day it would seem as though I had injured a tendon, but the next it would feel as though I had an inflamed muscle or bursa. If I attempted to use my arm for minor tasks, such as carrying a medium-sized bag of household waste outside to the trash receptacle it became weak and unusable for the rest of the day.

I tried everything I knew to make my shoulder well again. I took anti-inflammatory drugs. I used a device designed to drive medication into the muscle. I made attempts to strengthen the shoulder with mild exercises. I massaged the area. Nothing brought any improvement in strength or lasting relief from pain.

After several months of futility I humbled myself and made an appointment to see a chiropractic physician about whom I had received favorable reports from a number of mutual patients. I introduced myself and said, "Steve, I don’t know if this has anything to do with your area of expertise, but I have a sick shoulder.”

"A high percentage of shoulder problems actually originate in the neck,” he replied. X-rays of my neck were normal, showing no arthritis or other disease processes, but a physical examination revealed that my range-of-motion was not what it should be.

He had me lie down and manipulated my neck. The resulting snap, crackle, and pop was reminiscent of a Rice Krispies commercial. In less than five minutes my treatment was complete. The results were apparent as soon as I got into my car and began to back out of my parking space.

I had been taught in my high school driver’s education class to check my "blind spot” when pulling out from a curb or when changing lanes. I had never been able to see behind the door post when doing so. As I turned my head to begin backing up I realized that I was looking out of the rear side window without turning my entire body! The range-of-motion in my neck had increased by at least 10 degrees in each direction!

I returned for two more "adjustments” over the following week. At that point it was clear that my shoulder wasn’t sick any longer. It took several weeks for my strength to completely return to normal, but I experienced no further pain or profound weakness.

During my first follow-up visit I learned that years of carrying my wallet in my right hip pocket had caused a rotation in my sacroiliac joint. This was easily corrected, and I have since kept the wallet in a front pocket, where it does not affect my posture while sitting and is less available to pickpockets.

Having experienced such dramatic results, and with a newfound appreciation for what could be accomplished by a skilled chiropractic physician, I asked to be taught how to identify challenges that were amenable to chiropractic treatment.

Steve was happy to comply with my request. He showed me how joints in the spine that are locked and not moving freely cause one side of the pelvis to be pulled higher than the other so that one leg appears shorter when an individual is lying flat. On several occasions I had dismissed as nonsense or trickery reports of patients that a chiropractor had caused a leg that was two inches shorter than the other to become the same length. Those accounts suddenly made sense.

I observed how a rib that was not seated properly would cause the patient’s heel levels to move up and down as they took deep breaths. I learned that tender, painful rib joints along the breast bone were almost always due to a misalignment of the rib near the spine.

I had been taught to inject joints or tender muscle knots with cortisone-like drugs and to treat swollen rib joints with non-steroidal anti-inflammatory drugs. Such measures suddenly sounded incredibly ill-conceived and unlikely to resolve the condition. I had found those treatments unsatisfactory in the past, but had known no other option to offer. Now I could tell those consulting me how to actually correct the problem and obtain lasting relief from their pain.

I soon learned firsthand just how effective manipulative therapy could be in resolving localized muscle pain, referred to as a "trigger point” in the upper back. Shortly after my shoulder problem had been corrected I attended a medical meeting in Seattle. At that time I did not own a suitcase with rollers, a feature I now insist upon and highly recommend. I therefore carried my suitcase from my rental car to the hotel lobby.

The following day I awoke with sharp pains radiating from a tender muscle knot midway between my shoulder blade and my spine on the right side of my upper back. One of the exhibit booths was offering massages. I took advantage of the opportunity, but it did little to relieve the pain. As soon as I returned home I made a chiropractic appointment. The weight of the suitcase had caused one of my thoracic vertebrae to rotate out of position. A quick pop of my back immediately relaxed the muscle and eliminated the pain.

Once I began looking for locked joints, which chiropractors refer to as subluxations, I found that a number of issues I had been treating with medication or surgery could easily be corrected with spinal manipulation. Some, such as the elimination of post-whiplash headaches were not surprising. There were other conditions, however, that I would never have suspected of being correctable through joint manipulation.

Shortly after I had learned that ribs could become slightly dislocated, a man came to me complaining of wheezing and shortness of breath. He was in his mid-forties and had no prior history of asthma. Before learning about rib issues I would have prescribed inhalers to calm inflammation and relax muscles in the man’s bronchial tubes, but I now had the ability to check for a rib problem. I asked him to lie down and I observed that his feet did indeed move up and down as he took a series of deep breaths.

I asked him if anything unusual had happened before his breathing difficulty had begun. After thinking for a moment he replied, "Yes, I fell and hit the right side of my chest shortly before the wheezing began.” I referred him to a chiropractic physician and his "asthma” was cured with a single adjustment. I can only wonder how many people have been sentenced to a life of breathing difficulty and reliance upon medication when a simple solution to their difficulty was available.

I do know that a sizable percentage of gallbladder operations are performed unnecessarily. The emphasis of my medical education was internal medicine – diseases of internal body organs. I received very little training in structural medicine – in the diagnosis and treatment of skeletal anomalies. This is true for most medical doctors. Therefore, when someone presents with pain in the right upper quadrant of the abdomen the physician thinks only about what internal organ could possibly be causing the pain. Since it is the only organ located in the area that would normally be expected to cause pain the gallbladder is almost always blamed when right upper abdominal pain or right lower chest pain is reported.

In some cases a gallbladder problem is the source of the pain. In these cases an ultrasound study of the gallbladder reveals a thickened wall consistent with inflammation. Small stones are commonly seen and often one or two stones may be found to be obstructing the drainage of bile from the gall bladder. Liver enzymes are typically elevated. If a gallstone has lodged in the common duct that carries bile from the gallbladder and digestive enzymes from the pancreas, the pancreas will be inflamed. Such cases are surgical emergencies, as an inflamed pancreas (pancreatitis) or liver (ascending cholangitis) can be fatal.

More often than not, however, gallbladder ultrasounds and liver function tests are found to be normal. In a sane world, that would be enough to absolve the gallbladder of any blame, but in the world of modern medicine it does not. When right-sided abdominal or chest pain persists, physicians order a follow-up test called a HIDA scan. The test is also known as cholescintigraphy. A radioactive substance that concentrates in the gallbladder is administered intravenously. The individual is later given an injection of cholecystokinin, a hormone that is normally released by the body following a meal. The cholecystokinin causes the gallbladder to contract and eject its contents into the small intestine.

If the gallbladder does not appear to be contracting efficiently it is said to be non-functioning or poorly-functioning. Despite the fact that poor gallbladder contractility is seen in people who have perfectly normal gallbladders, an abnormal HIDA scan is routinely used as a reason to remove the gallbladder of anyone complaining of right upper abdominal pain. I have never been able to understand how removing a poorly functioning gallbladder will improve its function, but such is the strategy of most physicians when they see an individual with right upper abdominal pain and an abnormal HIDA scan.

In nearly every instance in which I have seen an individual with right upper abdominal pain and a normal gallbladder ultrasound, my examination has revealed a misaligned rib. Correcting the alignment has resolved the pain and allowed the person to retain his or her gallbladder. This is a very good thing, since the gallbladder is designed to release a bolus of bile following each meal to aid in the digestion of fats. Individuals who lose their gallbladder often experience gassiness and bloating after meals, especially those that contain fatty foods. Taking digestive enzymes with meals helps alleviate those symptoms, but it is always better to have a gallbladder capable of responding to the demands of fat digestion. While I have not asked individuals to repeat their HIDA scan after the rib issue has been addressed I suspect that would be normal in most instances, since the nerve irritation that is causing the pain may also be impairing the gallbladder’s effectiveness.

Restoring normal mobility to spinal joints is beneficial in relieving acute pain syndromes, but the long-term implications of doing so may be even more important. The human spine is made up of 33 vertebrae. Five are fused to form the sacrum and four make up the tailbone. The remaining 24 vertebrae are separated from each other by intervertebral discs. The discs serve as shock absorbers for the spine and maintain adequate space for nerves to pass from the spinal cord in route to their destinations.

An intervertebral disc is somewhat like a jelly doughnut. The outer aspect of the disc (the dough) consists of strong cartilaginous fibers that distribute weight and jarring forces evenly throughout the disc. The center, called the nucleus pulposus, is a jelly-like material that absorbs the impact of activities upon the spine.

The nucleus pulposus must have a high water content to function properly. If it becomes dehydrated it loses much of its shock-absorbing ability. This in turn causes greater forces to be applied to the surrounding fibers, weakening them and making them more susceptible to tearing.

The gradual deterioration of the nucleus pulposus due to dehydration is called degenerative disk disease. This can be a very painful, disabling condition. Unfortunately, degenerative disk disease is quite common in our society.

When the outer fibers tear the nucleus pulposus can be squeezed through the opening. This is referred to as a ruptured or herniated disc. If the exuded material presses on the adjacent nerve, pain, numbness, tingling, and weakness can result.

Intervertebral discs rely upon movement of the spine to pump water into them. Therefore, if a joint becomes locked and remains so for a period of time, the associated disc can become significantly dehydrated. This will predispose the individual to degenerative disc disease or disc herniation. Since degenerative disc disease is irreversible, prevention is of paramount importance.

Awareness that structural issues can be addressed effectively by skillful manipulation has done much to improve and maintain the quality of my life. More importantly, it has given me a valuable tool in helping those who consult me restore and maintain their health. I encourage you to consult with someone trained in manipulative techniques when dealing with persistent pain, especially if initial studies to determine the cause of the pain have been inconclusive. If the pain is due to a structural issue restoring normal function can yield immediate and long-term benefits.

Addendum:  Thanks to excellent chiropractic mentors I have been able to learn non-manipulative techniques for correcting structural issues.  This "kinder, gentler, approach" is extremely effective and addressing headaches, chest pain, and back pain related to structural issues has become one of the most rewarding aspects of my practice.

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