Wednesday, July 25, 2012

Prolotherapy... Good, Bad, Evil????


There are many tools and techniques to choose from in the world of medicine. Recently I’ve been asked about what I thought about prolotherapy…is it good, bad, evil?

Well, let’s go over it…

The first thing you have to realize is that you need to love needles…or at least tolerate them.  Prolotherapy involves injecting dextrose, lidocaine (a common local anesthetic), phenol, glycerine, or cod liver oil extract into a really flimsy, overstretched tendons or ligaments for the purpose of strengthening the suspect tissue to try and relieve musculoskeletal pain.

Prolotherapy sessions are done every three to six weeks, gradually tapering off over time until they are, hopefully, no longer needed.

Like any technique, there is a bit of an “art” to it. So the more experienced the doctor is the better. You don’t want someone to “practice” this on you.

The concept is simple. A joint is forced to move more than it’s designed and its tendons or ligaments become flimsy. However, unlike a muscle, you can’t make tendons and ligaments stronger with resistance training. Instead, the trick is to somehow get them to shrivel up, get shorter and thicker...the body's natural response to direct trauma with a sharp instrument. Kind of like a face lift.

Or you could remove the perpetual cause…but we’ll get to that later.

Basically, prolotherapy injections irritate the heck out of the involved tissue to get it to thicken-up and get stiffer. That’s the goal. Essentially it’s a skillfully applied scar.

Another technique, referred to as “needling”, has a similar objective. Picture a Roman doctor stabbing a hot needle into a gladiators “unstable” shoulder. Today’s less barbaric version of needling is becoming very common to use on horses.  And now that I’m thinking about it Platelet Rich Plasma (PRP) Therapy probably works via the same mechanism, and may have nothing to do with the red blood cells or the growth factor they try to inject.

There’s a good history with this approach. But other than direct injury, why would someone, other than a gladiator, need to give their ligaments and/or tendons a face lift?

Well, like any chain, if there is a rusty link, the adjacent link will move more than it’s designed to, and wear out faster than normal. In this case, the ligaments that are suppose to limit the joints motion, and the tendons that the muscles use to move and stabilize the joint, can get trashed over time, if the joint is forced to compensate for an adjacent “rusted” joint.

If you have any structural abnormality, you will have a bunch of “rusty” joints, all over your body, which will force their neighbors (above, below, other side) to become “flimsy” to one degree or another.

“Flimsy”, hypermobile joints are usually the ones that end up hurting. Naturally, these are the ones that can be candidates for prolotherapy.

But, you have to ask yourself…What’s the sense in doing prolotherapy on a joint that is just going to get loose again anyway? It’s like lubing the loose links and ignoring the rusty ones.

This is how I think.

The PRIMARY conditions, that can lead to a joint-hypermobility, that I focus on correcting, include: Short Leg Syndrome, Compensatory Lumbar Scoliosis and Anterior Head Syndrome… which result in the loss of the normal loading of the vertebrae, resulting in abnormal joint movement, abnormal mechanoreception (joint dysafferentation in general) which is never limited to the spine, because the extremities almost always end up getting caught up in the mix. Especially the lower ones

It’s valuable to understand how things are connected. How a SYSTEM works. How the hip bone is connected to the…

So, for some patients, prolotherapy is a possibility.  It takes advantage of the body's natural reaction to direct trauma, skillfully applied with a needle, hopefully. It's not good, bad or just doesn't make sense if you aren't going to provide the hypermobile joints a better environment, by giving the “flimsy” joints some slack, to reduce or eliminate the primary condition (rusty link).

Of course there is the occasional exception…Some links just can't get unstuck.

Wednesday, July 18, 2012

"Pop n Pray"

Wow! I was just blown away today when I heard this saying come out of a complete stranger’s mouth…“Pop n Pray” is a derogatory term that is usually used to describe Traditional chiropractic, and because of that I’ve NEVER said it around patients. I love Traditional chiropractic, and think it truly helps people who don’t have any structural-abnormalities of the spine or live somewhere were they don’t have any other option.

I just couldn't believe my ears. My jaw literally dropped when he said it. It was incredible hearing it come from someone I just met and wasn't another chiropractor like myself.  Prior to today, I only heard this at technique seminars.

Here’s what happened, best I can remember…

I dropped by the coffee shop and on my way out this guy saw my race bike and asked me a few questions which led to a conversation about what I did for a living, since I can’t make money racing bikes (I must look like a pro, lol!)…We were talking about bike racing and he mentioned that he had a bad crash while racing BMX. Turns out he broke his pelvis, but the hospital somehow missed it. It wasn't until he went to a chiropractor, who focused on structural correction (not his exact words but mentioned another structural technique) picked it up during his structural exam.   

Luckily, he had a great experience that wasn’t limited to just that chiropractor either, as he needed surgery and physical therapy as well.  I was just as shocked that he went to a structural-based chiropractor. There's not that many of us!  When I told him that my practice was limited to structural correction, like his old chiro, he replied, “regular chiropractic is just pop n pray”.

I wanted to high-five him…but I like to downplay that stuff in public. I really do appreciate traditional or “regular” chiropractic…the chiropractors are a different story all together, sadly.

Anyway, this chance meeting got me thinking more about the differences between Traditional chiropractic care and Corrective Chiropractic’s Structural Corrective care. It’s something I need to work on personally, so I can communicate what I do…it's something that takes more than a catch-phrase.

Corrective Chiropractic
  • Increases ranges of motion
  • Decreases muscle spasm
  • Decreases pain
  • Most common form of chiropractic care you can find
  • There are many techniques or styles that use anything from the well-know hands-on “cracks”/manual manipulations/adjustments to low force instruments to achieve their goals
  • Complete Structural Examination…no guessing, no “pop n pray”
  • Restores spine back to its normal ranges
  • Restores normal function of the spine and pelvis
  • Complimentary Requirements that leave almost “no-stone unturned” from the ground up
  • Increases ranges of motion
  • Decreases muscle spasm
  • Decreases pain
  • After your care is complete, which takes TIME, the Complete Structural Exam is repeated so we can measure and SEE the correction you attained  
  • Educate patients on how to maintain their correction so they are not dependent on us FOREVER. We want you to keep your correction
  • We do not cater to the insurance company’s standards nor are we limited to their coverage
  • Take pride in NOT SETTLING, so we NEVER stop searching for ways to provide a better service

Most of my patients come here, or to similar style practitioners, because they were tired of patching up a problem that returns over and over again.  They were not SEEING or feeling the results they expected because the underlying structural abnormality problem was perpetuating their problem. An uncommon approach that made a lasting impression on this guy. It really made my day.