My journey of becoming a Chiropractor
I opened my practice in Berkeley, CA in early December 2013. We are located in the heart of the Elmwood district at 2900 Telegraph Ave at Russell St.
Please visit us here to learn more about the services we provide and office hours. We are taking new clients and have very affordable grand opening rates.
Or contact drarieldc@gmail.com
Oh goodness, I have neglected this outlet and am returning to dust off the cobwebs and entertain my dear followers with some visual excitement of what I’ve been up to over the past, uh…. 5 months. (sheepish smile)
Let’s begin with May, a month heavy with celebrations for my mother… Mother’s Day, her birthday, and another year accomplished in the marriage department! And while I much rather would be celebrating her wonderfulness and life, I was studying a mother load of information for the final (THANK GOD!!!!!) stint of my National Board exams, the clinical ones that once passed allowed me to apply for my state licensure. Before boards, I suffered from a little bout of plantar fascitis. Wow talk about pain, I couldn’t walk well for a few days. I chalked it up to not being able to take a step into my future without addressing physical healing of my feet, ie my grounding foundation, and got a bunch of graston work to strip the fascia which did wonders!
My right foot, looking good thankfully, but ouch!
Kinda crazy from studying at this point!
So while I wait for my boards scores, I’m hustling to complete my numbers to check out of my clinical internship, getting ready for our senior trip, graduation and all the celebrations that come with that as well as a chiropractic service trip to Jamaica. It’s been one of the busiest times of my life!
Senior trip camping and white water rafting on the South Fork of the American River.
A lot of laughter!
And if we looked like this all the time…..
… we might never have any fun like this…
So, I went through the formalities and was honored to have my diploma presented to me by my father, a master of his chiropractic craft.
Also honored to have my technical and moral support right by my side!
And then we celebrate more!
I gear up, pack my spine and head off to Jamaica for one of the most heart opening experiences ever…..
Dr. Tracey Wright of Globalivity created a sacred space for our own healing and shared her heart and soul with all the people we encountered on our journey!
This woman sold us jamaican apples and got a sweet adjustment… and proceded to bruk it down!
Speaking to the community about the spine and what we do as chiropractors.
Adjusting children of all ages.
We adjusted hundreds of teens in the front entry to their vocational high school as well as orphaned boys aged 12-17 at a child care facility. They were either excited and curious, sometimes hesitant and all got off the tables with a huge smile. It was such a gift to share with them!
Our final night adjusting at the Treasure Beach Women’s Group.
On our final day, we took a surprise trip to the infamous Pelican Bar…..
I left my mark…. Bringing my future practice to life.
After I returned from Jamaica I drove to Washington State to continue healing from the long haul of the last 5 years and continue learning while working in my dad’s practice. And playing in the woods, beaches and water ways of the Great Pacific Northwest….
Skokomish River
First day of work!
Lake Cushman
Kayaking in the Puget Sound on the way to Hope Island with Mt Rainier in the background.
Second Beach on the Olympic Peninsula
I learned what it cost to have a home birth and first 3 months in 1979… $655.29! Something is missing these days….
Found the receipt for my first adjustment at 5 days old by the legendary Dr. Maxine McMullen
Yup, chiro baby, from the beginning…..
Celebrated my new year in late August with a lot of good food and great company
In early September, I returned to the Bay Area to begin my practice. I’ve spent hours visiting with docs collecting all the tidbits about business and practice I never learned in school. As well as making ritual of being completely done with school. See fire pit below :
And I have had my first reunion with my chiropractic sisters… and we are all licensed doctors of chiropractic!
So, as I watch the light change and the leaves begin to fall, as much as they can in a place with mild seasonal changes, I give thanks for the completion of one journey and beginning of another.
This is my gratitude jar… a daily practice.
And finally, today I became the owner of Oakland based, FLOW Chiropractic and Family Wellness Center, location, hours, etc TBA. Please stay tuned!
All the Love!!
For the last 3 or so years, I’ve had this quote on the wall above my desk from a chiropractic mentor:
Tension is who you think you should be.
Relaxation is who you are.
~ Chinese Proverb
This has stuck with me throughout this school journey as I’ve studied tone and tension and how it is transformed in the human body through chiropractic work. When we are in the mindset of who the world expects us to be, it creates stress in the body. Stress can manifest as many things including brain imbalance, decreased function of the body’s systems including over activating the sympathetic autonomic nervous system, resulting in gastrointestinal issues and a malfunctioning immune system. All of these contribute to negative effects resulting in further issues, primarily pain, dysfunction and often most detrimentally negative/fear driven thought patterns.
When we are in the mindset of who we are, we truly are engaged, activated and connected to our source; what is reflected is relaxation. When the mind is relaxed the body can relax, the body can heal.
Because of the nature of our fast paced society in the United States, it has been made easy to forget who we are and focus on who we think we should be. It has been easy to engage in activities that propel us into a state of constant sympathetic firing.
When a woman engaging in childbearing is presented with stressors, it is all to easy to allow the tensions of life into her body causing effects that can be detrimental to herself and her future infant’s well-being. By engaging in Mindfulness-based Child Birth Education (MCBE, adapted from Mindfulness-based Stress Reduction, MBSR), a future parent can create a positive, empowering experience in which the woman and in turn future family can be more connected to their process.1 With a mindfulness practice, there is the opportunity for an alteration in the mental reaction causing a decrease in overall stress and therefore balanced physiology in which the parasympathetic nervous system functions a majority of the time, only allowing the sympathetics to engage when necessary.
The pediatric or family chiropractor has many factors to address when working with adults who are getting ready to parent including major hormonal changes which can result in mood changes such as anxiety, depression, fear and the sense that the emotional responses they are having are inappropriate. Incorporating components of the MCBE can improve the outcome of care, child birth and rearing, should the parent choose to participate in the mindful action.2 
Subtly chiropractic focuses on the course of action it takes for the body to appropriately adapt to stressors that alter physiology. Should a parent not adapt to stress in a healthy way, it can have profound effects on their parenting style, post partum depression, and effect the quality of infant-mother attachment. “Existing empirical evidence suggests that mindfulness-based interventions can reduce the impact of stress, improve psychological well-being and increase positive affect, alleviate anxiety and depression, prevent relapse or recurrence of major depressive disorder and a substance abuse, and improve immune function.”2 Along with introducing coping strategies for the mind it is possible to introduce new strategies for dealing with life through certain techniques of chiropractic. In fact that is one of the foundational focuses of Network Spinal Analysis and Bio-Geometric Integration. Both address tension as a form of creating stress in the body and by subtle releases introduces relaxation in the systems resulting in a properly adapting and functioning nervous system.
“.. The pregnant women participating in MBCP used mindfulness more frequently to cope w/ salient stressful aspects of pregnancy and family life post-intervention, suggesting that teaching mindfulness during the perinatal period may expand pregnant women’s repertoire of adaptive strategies for coping with stress. Participants reports staying in the present moment and taking a process view of there unfolding experience, mindfully acknowledging that each moment will pass and be replaced by the experience of the next moment through pregnancy, childbirth and parenting. Participants found this core aspect of mindfulness to be beneficial for their emotional well-being, their relationship quality with their baby and partner, and for promoting a sense of calm.”2 If this was something I could encourage and employ my pregnant patients to participate in, I would be a very happy chiropractor, because I truly believe this is them awakening to their highest potential.
The human body is perfect in balance, is perfect life, is perfect function and perfect love. Chiropractic treats the human body when it is out of balance and the cause, allowing people to function at their highest potential. Women embarking in creating a new life are thrown into a whole new form of striving for perfect balance and MBCP and MCBE offer a wonderful place to start.
References
1. Fisher C, Hauck Y, Bayes S, Byrne J. Participant experiences of mindfulness-based childbirth education: a qualitative study. BMC Pregnancy Childbirth. 2012 Nov 13;12:126. PMCID: PMC3534482.
2. Duncan LG, Bardacke N. Mindfulness-Based Childbirth and Parenting Education: Promoting Family Mindfulness During the Perinatal Period. J Child Fam Stud. 2010 Apr;19(2):190-202. PMCID: PMC2837157.
Things are winding down on the school front! And while I finish up classes and clinical requirements, I’m also raising funds for a service trip to Treasure Beach, Jamaica.
Please check out my campaign page and donate if you feel moved.
Much Love and Blessings!
Following is a case study on one of my patients in the Health Center at LCCW. I wrote this for a research class, so once again, it’s pretty techie, but something our field is working on is building our scientific research, so here is my first contribution. Enjoy!
Case Study: Non-specific Low Back Pain: A Quick Response to Chiropractic Care
Abstract
OBJECTIVE: To show the outcome of chiropractic care for a patient with lumbalgia while exercising.
CLINCIAL FEATURES: The patient was a 28-year-old woman who presented with complaints of low back pain while exercising. Aberrant spinal biomechanics and fixation of joints were diagnosed from physical exam findings. Prior to care she had taken over the counter anti-inflammatory medications to alleviate pain along with having positive previous results from chiropractic care.
OUTCOMES MEASURES: Changes in this case were measured through thorough static and motion palpation findings to detect change in spinal biomechanics.
INTERVENTION AND OUTCOME: Diversified chiropractic care was delivered to areas of the pelvis and lumbar spine that displayed decreased range of motion and fixation of joints. Throughout the course of 11 chiropractic adjustments, the symptoms resolved completely allowing the patient to return to her normal activities. Continued adjunctive care has helped this patient remain pain free.
CONCLUSION: This case report illustrates that patients presenting with non-specific low back pain benefit from chiropractic care. Further research in this area would benefit the large population of people who suffer daily from lumbalgia.
Introduction
Low back pain, also known as Lumbalgia, is a common complaint among people all over the world. In the United States this condition is often seen as a serious public health concern because of its effects on occupational productivity, resulting in financial costs as well as social costs.1 According to Balague, et al, “most people will experience back pain at some point in their life” yet few, less than one third, will seek care. 2 They refer to people of all ages from adolescents to the elderly predominantly affecting those aged 35-55. The CDC reports industrialized nations can expect an estimated prevalence of 70%3 and a 2012 study showed that just over one quarter of adults, of both genders, had experienced low back pain in the previous 3 months and 55% had the experience in the last year.4
A definition of low back pain must also be considered as some cases are mild while some are severe. Mild cases are often labeled acute in which the duration of pain is under 3 months and more severe cases are considered chronic in nature lasting longer than 3 months.5 It is important to note that those who suffer from acute cases may also experience recurrent episodes of low back pain throughout life.
Because it is subjective, a patient presenting with a history of lumbalgia is often enough to diagnose the condition. Within the chiropractic field however, orthopedic exams are used to determine more specificity as to what is actually causing the pain in the low back region, differentiating it from pain generated from the pelvis. According to Lehman, it is imperative to be able to differentiate normal spinal biomechanics for a proper diagnosis of low back dysfunction. He states, “A diagnosis based on function via tools and techniques to quantify dysfunction provides a means to assess a patient’s current condition separate from their subjective perception of pain.”6 The authors of The Burden of Musculoskeletal Diseases show disc degeneration is the most common low back diagnosis, which is directly related to aging, an alter in spinal biomechanics, and a recent correlation with genetics.7
Traditional treatment of non-specific back pain consists of over the counter NSAIDs, pharmacotherapy and physical therapy, and surgical intervention as deemed necessary for those with progressed neurological symptoms or deficits. Complementary Alternative Medicine (CAM) is often considered for those who do not choose to address their condition with traditional medical treatment. In many cases, those patients who have already tried “everything else” approach CAM. This often includes massage, acupuncture, and spinal manipulation in the form of specific chiropractic care.
Low back pain is one of the most costly conditions in the US with a reported estimate of $84.1 billion to $624.8 billion in direct and indirect costs, including loss of work, as well as being “the second most common reason for visits to physicians”.4
Low back pain is, more often than not, a complaint of the musculoskeletal system along with the nervous system. Both of these are addressed specifically by chiropractic through the use of high velocity, low amplitude spinal adjustments. “Chiropractic doctors typically serve as portal of entry providers focused primarily, although not exclusively, on neuromusculoskeletal disorders.”8 Because of the conservative, hands on approach that chiropractic takes on low back pain with an emphasis on patient education, exercise, diet and lifestyle recommendations, they generally help patients get well faster than an allopathic approach. In an article evaluating chiropractic management for low back disorders a group of chiropractors managed low back cases with similar evaluations, treatment plans and reevaluations, paying particular attention to red flags. The group came to 80% consensus that this specific care was best for patients with low back pain.8
Case Report
A 28-year-old female patient presented with a primary complaint of low back pain, typically occurring 2-3 times per week while she was on a regular work out schedule of cardio exercise and weight lifting 5-6 days a week. The low back pain, which began in 2008, was insidious in onset and related to stress. She reported the pain was located in her lumbo-sacral area and “moved around” to her flanks. The pain was worsened through too much working out, dancing, or occasionally sleeping in the wrong position. Usually this pain lasted 4-5 hours, but sometimes was reported to remain constant throughout the entire day, even waking her up at night. The patient reported a VAS of 5/10 and 9-10/10 when at its worst. The patient reported her activities of daily living were limited, directly impacting her ability to participate in recreation without pain, as clearly illustrated through a GPDIQ score of 3. She reported a previous positive experience with chiropractic, earlier in the year.
The physical exam revealed abnormal posture in which the right ilium was slightly higher than the left. The lumbar active range of motion was limited in bilateral lateral flexion at 25/30 degrees as well as being limited in bilateral rotation at 25/30 degrees. Palpation revealed slight edema and hypertonic multifidus and quadratus lumborum musculature bilaterally from L3 to both SI joints. Muscle strength testing revealed a slight decrease in strength of the left psoas. The Prone Leg Check was positive on the right and ¼” short. The Supine Leg Check was positive on the left and ¼” short. Standing Gillet’s test revealed a fixated right ilium with bilateral cavitation during sacral motion. Kemp’s test on the right was negative for disc involvement yet produced left sided low back muscle pulling indicating local spastic musculature and possible facet involvement. Yeomen’s test on the right sacroiliac joint revealed decreased ROM with no reported pain indicating fixation of the right sacroiliac joint.
Evaluation of radiographs showed knife clasp deformity at L5/S1. Though suspected, there were no degenerative changes revealed in the lumbo-pelvic region. Motion palpation of L3 found misalignment and fixation to the right. Motion palpation revealed fixation of the right ilium posterior inferior.
The clinical impression was chronic moderate to severe frequent lumbalgia.
Intervention
After the patient had been properly examined and assessed for subluxation through static visualization for asymmetry in posture, static palpation for tonal changes in the tissues and motion palpation to detect fixation and restricted range of motion in the spine and pelvis,
chiropractic care began with adjustments to correct the posterior inferior right ilium. The procedure was to place the patient with her left side down in side posture position squaring the shoulders and hips on the diversified adjusting bench to remove any potential rotation.9 The doctor brings the upside hip and leg into flexion taking the joint to tension with their contact hand and delivering a high velocity, low amplitude (HVLA) adjustment through the plane line of the joint. Subsequent visits addressed subluxation of the lumbar spine also in the side posture position with the patient lying on the side contralateral vertebral spinous rotation. All adjustments were delivered manually with a HLVA thrust.
The patient was adjusted 11 times over an 8 week period using Diversified technique as described by Dr. Michael Schmidt in Diversified Technique.9 Adjustments of the right ilium were given on the first and second visits of this study. These adjustments were performed with the subject lying on an adjusting bench on her left side in diversified side posture position. The contact point was the posterior superior iliac spine with the pisiform of the doctors contact hand delivering the force. The doctor was in lancer’s stance supporting the patient and stabilizing the patients’ right shoulder. Adjustments of the 3rd lumbar vertebrae were given on visits three through six, nine and eleven. These adjustments were performed with the subject laying in diversified side posture position on her right side. The doctor was in lancer’s stance supporting the patient and stabilizing the left shoulder with the contact hand’s pisiform contacting the ipsilateral spinous process. Adjustments of the 1st lumbar vertebrae were given on visits seven and eight of the study. These adjustments were performed with the subject lying on her left side on a bench in diversified side posture position. The doctor was in lancer’s stance supporting the patient and stabilizing the right shoulder with the contact hand’s pisiform contacting the ipsilateral spinous process. For each adjustment, the thrust was delivered through the pisiform of the doctors contact hand as the patient was brought over for the proper line of correction.
Following each adjustment the patient was re-assessed by static and motion palpation to verify the adjustment had altered the tone, reduced the fixation and increased the range of motion.
Visits occurred 1 time per week for the first 3 weeks of care, 2 times during the 4th week of care, 1 time per week for 4 weeks and 1 visit for the last week.
Previous experience with this kind of case is limited to 4 other cases this doctor has treated in her short career as a chiropractor. In each of those cases, the patients reported decreased pain and beneficial outcomes.
Outcome
Initially the symptoms the patient reported as lumbo-sacral pain bilaterally into the flanks. The subject described the pain as sharp and sometimes referring up the spine. There were no radicular symptoms reported. Upon the initial visit the Visual Analog Scale (VAS) was a 5/10 and at its worst 9-10/10. The General Pain Disability Index Questionnaire (GPDIQ) was a 3 and activities that aggravated the complaint were: too intense of a work out or hiking or dancing and occasionally sleeping in the wrong position. At the second visit, the patient reported no pain in the low back since the first adjustment. During the third visit the patient reported mild pain, a 1/10 VAS, and that she was asymptomatic for one day, had slept more hours than normal and woke up with a return of low back pain. Upon presentation to care the pain had improved with movement. The patient was asymptomatic for visits four through six. Upon the seventh visit the patient reported a day of cleaning and yard work along with a family visiting and a heavy work out the previous night which caused the low back pain to escalate to a VAS 7/10. At the following visit a VAS 0-3/10 was reported and then she returned to being asymptomatic for the remainder of treatment. At visit ten, the patient was completely clear of lumbar or pelvic subluxation and the patient reported an absence of lumbo-pelvic pain with a VAS 0/10.
Upon the re-evaluation, the patient reported a 99% improvement in low back pain, which only occurred 1-2 times per month lasting 2-3 hours. A 0/10 VAS and 0 GPDIQ was reported. Changes in the patients’ presentation were documented upon re-evaluation exam as follows: the right hip was more level with the floor and there continued to be slight edema bilaterally over the sacro-iliac joints. Range of motion in the lumbar spine increased to a normal range. Psoas muscles that previously had been weak were now strong. The Prone Leg Check revealed even legs. Previous orthopedic tests including Kemp’s, Yeoman’s and Standing Gilet’s (all of which had elicited symptoms or tightness) were negative.
The patient reported, “Chiropractic care has been the best thing that happened to me in the past year.” She has since returned to working out more regularly, but continues to limit the intensity to prevent aggravation of the low back pain. It was recommended that as the patient increases work out load, she return for care every 2 to 3 weeks to help maintain the asymptomatic state.
Discussion
This case is an attempt to describe how chiropractic care for non-specific low back pain can assist one patient’s journey from a symptomatic to an asymptomatic quality of life. The use of HVLA chiropractic adjustments to the fixated segments in the lumbar and pelvic regions of the spine resulted in a consistent decrease in the reported levels of pain while increasing efficacy of spinal biomechanics. The body is a naturally healing entity. There is enough evidence present to demonstrate how spinal manipulation affects the central nervous system causing the brain to “reset” its interpretation of pain and discomfort resulting in substantial relief for the subject. Through the application of HVLA, increased activation of the neuronal afferentation in the muscle spindles is initiated, eventually culminating in a complete summation and silence, at the point of force application. This silence in muscle spindle receptors allows for normal sequencing, recruitment and coactivation of muscles to stabilize and protect the spine as well as return the joint to a normal range of motion and has the potential to decrease pain.10
In accordance with recommended management for non-specific low back pain, Balague, et al, discusses spinal manipulation and treatment of this course as part of most clinical practice guidelines.2 The specific protocol utilized to provide chiropractic care for this patient’s condition was selected based on clinical experience of the researcher, and in accordance with the clinical guidelines of the Health Center at Life Chiropractic College West. This case supports the efficacy of HVLA in the treatment of lumbalgia, as outlined in the studies mentioned above.
During most of this study, the patient had decreased and irregular physical activity causing a decrease in symptomatic presentation. In the middle of the study, an abnormal increase in the amount of physical work occurred, placing increased stress on the subjects low back causing an increase in symptomatology. This is an example of the uncontrollable variability of patient lifestyle. Although core-bracing exercises were recommended as a part of the management plan to help strengthen and protect from further exacerbation of lumbalgia, patient compliance is a large variable and hard to account for. The patient reported successful completion of the exercises, but accuracy cannot be ensured, as the subject was not held responsible for recording the activities on a daily basis. A final limitation is the absence of validation by an external group of researchers. Placebo care was not implemented in this study as it is a case study.
It is well documented that those who suffer from acute cases of low back pain are likely to suffer from recurrent issues.2 An important variable to consider in this study is the relative limited experience of the practitioner performing the care. Although positive results were achieved with regards to the patient’s symptomatic state, it could potentially have been achieved sooner had it been performed by a more experienced chiropractor. This case assists in the confirmation of efficacy for HVLA manipulations as intervention for acute lumbalgia; as also reported by Globe, et al, in which 40 chiropractors reached a high consensus about the specific recommendations for assessing and treating low back disorders.8
Conclusion
This case follows a 28-year-old woman through 8 weeks of chiropractic care to address her complaints of low back pain while exercising. Chiropractic care was provided using Diversified technique for the correction of subluxation in her pelvis and lumbar spine. After the initial phase of care, the patient reported a GPDIQ score of 0 and a reduction and frequency of regular low back pain while exercising. The CDC states the condition of low back pain has a 70% prevalence in industrialized nations.3 This case shows a favorable outcome for this individual, while demonstrating the potential for similar successes for the multitudes of people who suffer from low back pain. However, studies which include a larger sample size, specific guidelines for selecting cases, and appropriate documentation of patient reported treatment plan adherence would help gain substantial evidence of how specific chiropractic spinal manipulations contribute to resolving low back complaints.
References
All Material Copyright © 2013 by Ariel Provasoli
A little lesson on what I do……
Where there is pain, there will be strength.
Where there is sadness, there will be wisdom.
And where there is fear, there will be renewal and love.
Wisdom.
Many people hear the word arthritis and they think of achy joints and old people. Recently, I’ve crossed paths with a few (younger) patients who claim to have arthritis. I, after all my education still think of “old people”, and I think these folks have claimed this condition because of their aches and pains. So do they really have arthritis?What is really going on? There are many misconceptions about what arthritis is or isn’t, and yes, in chiropractic school we learn about it all! Here’s to sharing the news and showing you how chiropractic can help reduce the risk or help you cope.
Arthritis is a general term used to identify inflammation of the joints. There is inflammatory arthritis such as Rheumatoid Arthritis and then there is wear and tear arthritis such as osteoarthritis. And to get all nerdy on you for a moment the true term is Ostetoarthosis. Let me indulge my love of the history of language: Osteoarthritis from its Greek roots translates to osteo- “bone”, -arthro “joint” and -itis “inflammation” and is also known as degenerative joint disease (DJD). It is the most common joint disorder in the United States.(1) Osteoarthritis (OA) is an old name for the condition as it really does not cause inflammation of the joint but rather is a degenerative joint disorder.(2) (Inflammatory arthrosis conditions are in the family of rheumatic diseases.) According to The Arthritis Bible, the correct name is Osteoarthrosis but we are gonna stop geeking out and just refer to it as OA.
Arthritis disorders include Degenerative, Inflammatory and Metabolic disorders. The CDC defines OA as “a disease characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth” and goes on to say the degeneration of this area causes pain and joint stiffness.(3) So there you have it, degeneration causes pain and joint stiffness.
OA consists of certain factors that contribute to the disorder at primarily weight bearing joints such as the knee, hip and joints of the spine with one exception of the finger joints. It is less common but possible in the shoulder joint. (It is rare to see OA in the ankle joint.) These factors include systemic as well as local risk factors. Systemic risk factors are those things that occur in the course of our life that we have little control over and includes: normal aging, gender, hormones, race/ethnicity, genetics, congenital/ developmental conditions, oxidative stress and diet. The local risk factors include factors that can be prevented such as obesity, physical activity, physical injury, surgery, occupation, mechanical factors, alignment and laxity.(1)(2) Though there are many ways of developing OA, it only takes a combination of a few factors to have symptoms or be diagnosed with the condition.
The primary method for defining Osteoarthritis (OA) is through X-ray findings. However, OA can also be defined clinically or pathologically. Radiographic definition is through the Kellgren-Lawrence (K/L) grading scheme. Basically the grades tell the progress of the OA and include normal joints to joint deformity. There’s a lot of inconsistencies in this grading though. And it’s pretty apparent that if you’re feeling symptoms, something is going on and it probably doesn’t matter what the grade is to the average person as long as it’s taken care of properly.
Mechanism – this is important people!
OA usually begins with an injury or improper function (think repetitive use) of the articular cartilage of a weight-bearing joint. Problems with structures around the joint such as bursa, tendons, or ligaments can also contribute to the onset of the OA process, eventually beginning to affect the bone under the cartilage and wearing it down. This degeneration and abnormal growth of bone can cause pain, stiffness and sometimes swelling.(5) Because the human body is BRILLIANT and was designed for movement, the biomechanics are designed to function flawlessly as “health is maintained by a sophisticated chemical feedback loop.”(2) One simple injury or error can alter the joints’ homeostasis and send it into a degenerative cascade. However, this loss of perfect function also is a normal part of aging. Stress over time alters the body’s’ joints, but many sources say that the true cause of OA is unknown.
Presentation – what you’ll tell your chiropractor
Generally there is stiffness in the morning that gets better after about 30 minutes of being up. There might be complaints of pain and/or limitation of range of motion as well as stiffness of certain joints such as the hand, knee, hip, spine and possibly the shoulder and foot.(6) “The pain tends to worsen with activity, especially following a period of rest; this has been called the gelling phenomenon” writes Dr. Sinusas in his article Osteoarthritis: Diagnosis and Treatment. Because of a sense of joint locking or instability and pain, patients will allow the disorder to limit their daily activities. Is there something you don’t do on a regular basis because of they way your joints feel? This is exactly when and why you should consult a chiropractor to prevent further unwanted changes!
Key risk factors we look for are extensive. Given the progression of OA, age is the greatest risk factor because of the biological changes that occur with the aging process. Women are more likely to have OA as well as generally have more severe cases and as a result it is hypothesized that estrogen hormones could play a roll but studies are conflicting. Studies show that African Americans have a higher prevalence of OA as well as Chinese women compared to Whites. When thinking of the biomechanics of the body it is common sense to see an increased risk for those who do repetitive movements on the job, as hobbies or recreational physical activities. It is possible that OA is an inherited disease as well as can be caused by congenital or developmental factors such as Legg-Calve-Perthes disease or Slipped Capital Femoral Epiphysis early in life are associated with it as one ages. Diet plays a roll in almost all processes of life. Diet as a risk factor for OA is conflicting but sources agree that vitamin D is very important for bone integrity throughout life. Vitamin C intake also can contribute to changes in radiographic and symptomatic findings of OA. Low selenium levels have been associated with knee OA but high levels put a higher risk of developing hip and knee OA. Other risk factors include the obesity epidemic and the wear and tear that excessive weight has on weight bearing joints. Physical injury such as whip lash from an auto accident can be naturally brought about causing a strong factor for OA as well as surgery in which articular cartilage is brought damaged. Mechanical problems that cause OA include muscle strength that is greater in one area causing tracking, alignment and joint mobility to be altered. Limb length inequality can contribute to joint degeneration as well as increased laxity in ligaments.(1)
How it’s diagnosed
As stated above radiographic findings are another way to rule out other arthritic processes and diagnose OA. The presence of osteophyte activity and sclerosis (both fancy words for bone remodeling), joint narrowing and possible deformity are all expected x-ray findings for the degenerative OA. According to Yochum, there is a lack of symmetry, uniformity and often times OA is not symmetrical or on both sides of the body. Bilateral and symmetrical findings would indicate another process.(7) 
Lab findings can rule in other pathologies such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels which indicate inflammation. If rheumatoid factor is present, the antibody is found in about 85% of people w/ RA and a diagnosis of autoimmune arthritis is more likely.(2) Gout would be indicated by the presence of uric acid.(6)
A more expensive and definitely unneeded procedure for diagnosing OA is a synovial fluid biopsy, which would reveal cloudy, thick synovial fluid with abnormally large amounts of lymphocytes and neutrophils.(2)
As you can see though, because of altered motion in the joints and an x-ray, the chiropractor can diagnose OA for a lot cheaper.
Allopathic Management
Although there is no cure for OA according to the CDC, relief from symptoms and improving function is a main focus for the allopathic doctor and their OA patients. Mild OA patients are encouraged do nonpharmacologic treatments; exercise and loose weight if they are overweight. Physical therapy could be considered too as well as bracing or splinting. Acetaminophen is used for pain medication. If the OA becomes more moderate they begin use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen and encouraged to try something stronger if it is not effective. It’s a shame because these drug treatments cause other more serious side effects if taken long term. Moderate OA also calls for glucosamine and chondroitin supplementation but patients are not encouraged to continue using it if there is no change after 3 months. Once OA becomes more severe, patients are asked to consider opioid therapy, corticosteroid injections for acute knee OA and if it becomes persistent hyaluronic acid injection. A total joint replacement is a final step if all the other treatments are without success.(6)
Possible Red Flags
Should any joint degrade so much that there is bone rubbing on bone, a referral to an orthopedist is necessary. Surgery with a complete joint replacement might not solve the problem completely. Complete degenerative disc disease of the spine (DDD) often results in fusion of the vertebrae. There is favorable evidence of the success of replacements lasting 15 to 20 years.(6)
THERE IS ANOTHER OPTION – AND IT DEALS WITH THE CAUSE!
As you can see, in order to have ease in moving through life, your joints are a pretty important part of your daily activities. By getting regular chiropractic adjustments, a specific force is being introduced into an area where the joint is fixated and in some cases the possibility or beginnings of developing OA. Adjustment techniques for the senior patient or patient who may already have OA, include modifications that take into account the degree of joint and soft tissue stiffness as well as the need to assist with positioning and helping them to relax while in position. Sometimes manual soft tissue work and joint mobilization along with instrument adjustments for the osseous system benefit most. Taking into account the possibility of osteoporosis is important as well to avoid the possibility of fracture. 
Moderate activity is very beneficial to joints with OA. Exercises that tone the involved joints are recommended as a way of managing symptoms. “For weight-bearing joints, it is often helpful to begin with non-weight-bearing simulations of weight-bearing activities” such as swimming because of the decreased load on the legs from being in the water.(8) Bicycle riding is also suggested because of the passive range of motion the usually weight-bearing joints have to go through as well as the toning of muscles around these larger joints. You might need to modify your activities of daily living so you may perform them independently despite this arthritic condition.
Proper management also must include a nutritional component of Vitamins D and C as well as glucosamine and chondroitin sulfate. Glucosamine sulfate, known as “the cartilage protector” is a very safe and effective treatment for OA. Studies show that taking chondroitin sulfate daily as well has better relieving results than NSAIDS.(2) Many medical doctors ignore these supplements in favor of pharmaceuticals. Incorporating an anti-inflammatory diet will also be helpful. (Don’t know what that means? Think: decreased refined carbohydrates, few grains, less sugar and red meats. More green leafy vegetables and antioxidant providing fruits and foods.)
An expected outcome for OA patients with regular chiropractic treatment is for management of symptoms and this is a lot better than using medications with their millions of side-effects. Elderly patients cannot so much reverse the damage done to their well used joints, but through following a good treatment plan and regular adjustments and joint mobilizations feel better and have less symptoms.
The moral: Play hard, Live to the fullest and get adjusted!
Bibliography
1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010 Aug;26(3):355-69. PubMed PMID: 20699159 PMCID: PMC2920533
2. Weatherby C, Gordin L. The Arthritis Bible. Rochester, VT: Healing Arts Press; 1999.
3. Centers for Disease Control, Division of Adult and Community Health. Osteoarthritis [Internet]. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion; [updated 2011 Sept 1; cited 2012 Nov 23]. Available from: http://www.cdc.gov/arthritis/basics/osteoarthritis.htm
4. Hamerman D. Osteoarthritis: Public Health Implication for an Aging Population. Baltimore: The Johns Hopkins University Press; 1997.
5. U.S. National Library of Medicine. Osteoarthritis [Internet]. New York, NY: Langone Medical Center; [reviewed 2011 Sept 26; cited 2012 Nov 23]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001460/
6. Sinusas K. Osteoarthritis: diagnosis and treatment. Am Fam Physician. 2012 Jan 1;85(1):49-56. PubMed [citation]PMID: 22230308
7. Yochum T, Rowe L. Essentials of Skeletal Radiology. Volume 2. Baltimore: Williams & Wilkins; 1987.
8. Souza T. Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms. 3rd Edition. Sudbury: Jones & Bartlett; 2005.
A Doctor is defined as “a learned or authoritative teacher” as well as, “a person who restores, repairs, or fine-tunes things”. (Merriam-Webster Dictionary) While Doctored means to “change the content or appearance of in order to deceive; falsify.”
In the 1980’s the Chiropractic profession won a case in which the AMA (the American Medical Association) was found guilty of being hell bent on destroying the profession, those “Quacks”. They deemed chiropractors as “….a profession that in it’s treatment and diagnostic methods, which was sophisticated in an area that had been overlooked and otherwise in medical science.” Chiropractors, without treating symptoms or conditions and without drugs or surgery, were helping people get well and medical doctors, pharmaceutical companies and the insurance industry were just not down with that!
This film covers where our history has brought us and what we are doing to help people get well and stay well! It will make you reconsider the bigger picture of health in the US. Learn about managing Multiple Sclerosis, how detrimental pharmaceutical addiction can be, as well as vaccine issues, pediatrics chiropractic care and a possible cure for Cancer.
Do you want to live a lifestyle of chronic illness or a lifestyle of wellness?
Does regular exercise, simple supplementation and healthier diet changes cost as much as the cost of illness and disease?
Challenge your assumptions about the American health care system and the paradigm of sick care so many Americans are mortally addicted to because the approach their MD took was not guiding them or educating them to become free from disease but just to manage their symptoms, thus remaining in a state of illness.
Watch the full documentary here until Nov. 17th
I just got home from The Wave, a huge event put on by Life Chiropractic College West, dedicated to the art, science and philosophy of chiropractic. This weekend is jam packed with speakers from the profession, Doctors and CA’s. And it’s a testament to how strong the profession is. The message that I am clearly walking away from my short time there is simple:
Health is Liberation. And it’s Your Choice!
Mind and body are connected so completely through our brain and nerve system and being Well in all aspects are essential to attaining the longevity of a happy, healthy life. It’s the happy thoughts we think, the foods we eat and hopefully grow, the way we exercise and explore the world, the amount we meditate, rest and sleep, the quality of our relationships and the adjustments we receive that make us thriving, loving, aware people.
Dr. Joe Mercola really drove this home for me today. Check out his site. It might take you a few years to ingest much of it, but it’s a highly useful, legitimate source for “taking control of your health.”
Learning Hands, Healing Hands 