I’m probably going to irritate a few chiropractors with this blog, but hopefully they’ll read it to the end and realize what I’m preaching is the truth and not a self-sabotage (because I’m a chiropractor too) rant. From my experience practicing in the U.S. and here in South Africa, things are basically the same when it comes to the public’s perception of us quacks….once you start going , you have to keep going back, right?…arguably the most asked question on Google when searching for chiropractic information.
There are two answers to that question:
- I’ll start with the simple one and (like my dad) answer the question with another question. When you train your body for physical activity and you finally reach your fitness goals….do you need to stop training or do you need to keep going back to the gym? If you walk away from your training regime, what happens? Should I not have started training in the first place if it means I need to keep up the good work? You use the gym (or road or whatever) to get fit and then guess what? You continue to use it to keep fit, or search for higher levels of fitness that you couldn’t even begin to imagine were possible before you started your fitness journey.
- The second answer takes a little more thought and time to fully understand, but if you’re reading this then I’m assuming you really want to know why Chiropractic Alone doesn’t work.
What I write about here comes from my personal journey and how I’ve found my way out of the dark and finally seeing the light when it comes to Functional Movement, Functional Medicine and basically Functional Living in the context of Chiropractic care.
I’ve always been an athlete of some sort and recently I’ve made a return to Brazilian Jiu Jitsu after a 8-year CrossFit stint which started as rehab from a serious Jiu Jitsu injury years ago. When I can, I surf, trail run and do as much other physical activities as I can and frequently try to learn new sports or skills. I’m 49 years old and I believe I’m in the best shape of my life today because of the movement principles I’ll be writing about here.
I’ve always said that by restoring sound foundations in the way you move or the way you eat food, that will be the best medicine you ever take. While writing this I’m suffering from a small injury that is a direct result of me not following my own advice… fundamentals and foundational movement skills. So even armed with this information I, myself still need to be reminded.
Most people and far too many athletes or gym-goers have no clue how to move but they’re in the gym loading up the weights and doing back squats when they can’t do a Functional unloaded squat. It blows my mind! It’s like feeding a new-born baby a T-Bone steak and wondering why there’s a problem.
Chiropractic manipulation alone with no real understanding and application of how the body functions as a unified mechanism is outdated and seriously flawed. I, probably like many Chiropractors believed that the Chiropractic adjustment was a miracle tool, but sadly I’ve learned that it isn’t. Don’t get me wrong, I believe it’s a powerful tool, but it’s only one tool and if it isn’t used in combination with other appropriate tools (including education) then, it’s a waste of time and nothing more than a party trick.
As a patient if all you’re doing is lying on a treatment table while someone is doing stuff to you… needles, chiro, physio etc… That’s called Passive Care. That might be appropriate for a certain stage of care, but soon and I mean real soon that stage needs to come to an end and the stage called Active Care needs to start. Your injury is no doubt a result of a movement disorder, muscle imbalance or some sort of combination of both and the only way you get rid of that long term (so you don’t have to keep going back) is by learning to move better and the only way you learn how to move better is by YOU moving better and having someone to teach you how to do it. I can’t learn your movement patterns for you, YOU need to do the work.
And this brings me to another challenging topic that as practitioners we deal with all the time… and that’s the patient that doesn’t want to do their home care. The patient that expects the therapist to do everything and to magically get them better without changing their movement habits or adding strength or mobility to their physiology. I get it, not every patient is going to embark on a Functional Movement journey and relearn movement patterns and so maybe these are the patients that keep having to come back for temporary fixes to a long term problem.
Look at it this way… Actors mimic the outputs of the characters they play and often give us convincing performances, but these are scripted. The actor is not the character, but for a brief time, they behave like the character. We treat exercise and rehabilitation in the same way. We coach movements in a controlled environment and assume we have changed behaviour across other situations or even other activities. We forget that when the actor leaves the stage, he or she returns to their daily life eventually forgetting the character life. Our patients are no different. The way they move will tell the story of what they have learned and what they have forgotten.
The chiropractor needs to give the patient tools that will enable them to change how they move when they’re out of our office without even knowing they’re doing it. They need to become the “Character”. If your chiropractor isn’t doing this or attempting to do this then yes, you’re going to have to keep going back for band-aid temporary fixes….and my advise to you would be to find a new chiropractor… or physio or trainer that understands fundamental movement patterns.
The older patient’s physiology requires the same standard, structure and sequencing of movement as a younger more capable person…the only difference is in the intensity and degree of the loading. The exact reason I’m sitting with an injury right now. I’m 49, not 29 and most of the guys I grapple with are at least 15-20 years younger than me… I was managing the intensity, but I wasn’t managing the loading and now I have a problem.
The entire rehabilitation process should be focused on improving the overall functional status of the patient. It is of no real use to treat someone’s pain and then have them leave moving as dysfunctional as when they walked into your clinic… whether you’ve fixed their pain or not.
To break down what happens on the microscopic level to hopefully make more sense of what and why Functional Movement is so important is this… When an unexpected load is placed upon a joint, ligamentous damage occurs between 70 and 90 msec, unless an appropriate response ensues. Therefore, reactive muscle activity must occur with sufficient magnitude in the 40–80-msec time frame after loading begins, in order to protect the joint structures.
Each time a signal passes through a sequence of synapses, the synapses become more capable of transmitting the same signal. When these pathways are “facilitated” regularly, memory of that signal is created and can be recalled to program future movements.
Patients need to be trained, trained and retrained to move properly before the pathways become facilitated to create memory which results in quicker reaction times in that 40-80 msec timeframe… AND that’s what helps prevent future injury or re-injury.
This unfortunately doesn’t happen by simply adjusting someone or applying therapy to them. Their body needs to learn how to move to anticipate load and have the appropriate response. Learning takes time.
We can’t simply lengthen a tight muscle or move a stiff joint and think we have effectively changed a movement pattern, even though these very simple acts may be the fundamental starting point.
Our goal is to educate the body to move better. Its for this reason I love Jiu Jitsu for its ability to sequence efficient movement patterns in a physical chess match. What we need to remember is that pain is important, it’s a messenger that tells us when things aren’t working well. Pain is a signal to a problem, but it’s not the underlying problem.
So what I was saying earlier about your body’s ability to have an appropriate response when a load (expected or unexpected) is applied to it is basically a fault in proprioception.
Proprioception if you didn’t know is your body’s ability to be aware of itself in space…AND a reduction in proprioception will lead to compensatory muscle activation patterns.
The lack of proprioceptive input can arise from:
- Lifestyle changes toward a more sedentary life where the proprioceptors literally fall “asleep”!
- Comfortable conventional seating leads to less stimulation of the spine and therefore less proprioceptive output from the spinal proprioceptors, resulting in reduced activation of the core muscles.
Chiropractic adjusting can provide the proprioceptive input and mobility (and I guess this is the real “magic” of chiro)…but then we need to train the area and continue the work…the adjustment opens the door to the neural pathways and then we need to follow through with a systematic approach of rehabilitation. Rebuild those pathways to functional movement that ultimately promotes stability in the entire system.
To wrap up, let me put the ball in your court and leave you with this:
- It is important as a patient that you understand the necessary steps to develop a core training program.
- It is also important that you understand many variations of training and many opinions will be presented to you; however, there is a neurological framework and musculoskeletal structure that require a special sequential approach…and an app on your I-Phone or following some suggested stretches on Facebook isn’t going to cut it!
- You need to understand that basic human movement patterns build upon each other in a specific developmental sequence starting in infancy and developing through childhood.
- If you are suffering from Chronic Pain, you need to understand that you have more than likely lost the ability to move in the specific sequence required.
- You also need to understand that the most fundamental activities of the human body revolve around simple and basic movements of running and climbing. Ask yourself, how often are you running and climbing?
- You must also understand that the core runs on a reflex base. This means that the core musculature is engaged by reflexes in response to your actions and reactions. The movements of your core are reflex driven in an attempt to stabilize the spine so that more efficient movement patterns of the extremities can be produced. When the core must compensate, the effectiveness of the reflex with its natural sequence and timing is interrupted and a less efficient core that is more susceptible to injury is the result.
- Once adequate mobility has been demonstrated and the need for compensation has been reduced, it is important to understand the distinct difference between stability and strength. Many assume that doing crunches and increasing the strength of the abdominal musculature will produce a stable core. This is a simplistic approach and it fails to demonstrate the difference between stability and strength. Stability is the use of muscular timing, control and sequence to maintain a relatively stationary or stable spine in the presence of extremity movement. Doing more crunches demonstrates greater endurance and greater strength of the core but still does not guarantee that the core will stabilize in a striding or squatting movement. It is important to establish spine stabilization prior to core strengthening….otherwise as Gray Cook says, “you’re just stacking fitness on top of dysfunction.”
So that’s my roundabout second answer to the question earlier. Either your chiro isn’t applying fundamental movement patterns and corrective-exercise or they are and you’re just not doing the work.
Moving in a Functional manner is the thing that fixes movement disorders, asymmetries, imbalances and ultimately tissue trauma and pain. Yes, it takes time and effort and more than likely more than a handful of visits to your chiropractor. But if you really want to fix your problem, then this is how you do it.
Yours in health
Dr. Peter Solomon