Often I hear patients say, “I have sprained this ankle so many times.  I do the rehabilitative work and strengthen my ankle, but it just keeps happening.”  This is a common, and preventable, problem.

When an ankle sprain occurs, ligament tissue stretches and tears.  Of course it is important to apply acute care- think “RICE” (rest, ice, compression and elevation), and to do strengthening exercises once the acute inflammatory period is over (usually 48-72 hours).  There is, however, one commonly overlooked solution to keeping these ankle sprains from recurring:  proprioceptive rehabilitation.

I know, it sounds like a big word and it must be complicated, but it’s not.  Proprioception is our ability to know where we are in space without having to use our eyes.  Think about where your foot is right now, or your pinky, or your elbow.  You don’t have to look- you know where it is by the grace of your functioning nervous system.  The millions of nerve endings in your muscles, ligaments and joint receptors are telling your brain for you so you can keep your eyes glued to this blog!  It is this system, your proprioceptive system, that is damaged when you tear the ligaments of your ankle.

When you tear ligaments, you tear nerve endings.  Effectively, you lose some of the feedback that your ankle is constantly providing your brain when you are standing on your feet.  So even if you have done the proper acute care and subsequent strengthening, if you don’t re-establish the neurologic connection between your ankle joint and your brain you are unable to adapt to changes beneath your feet, such as a crack in the sidewalk or a slippery banana peel.  You need those nerves in the ankle to tell your brain what is going on down there!

A recent study in the American Journal of Sports Medicine followed soccer players with a history of ankle sprains and subjected them to various forms of prevention: orthotics, strength training, proprioceptive rehab and a control group.  Relative to the control group, proprioceptive training reduced the risk of ankle sprains by 87%.  This is an aspect of ankle sprains that cannot be ignored!

The exercises are simple and easy to implement, and can be done anywhere, but they do require some instruction.  So come on by Parkside Clinic or call and ask for a special proprioceptive evaluation.  Dr. Suppnick and I will show you some simple exercises to get you back out there with healthy joints, ready to stay that way.

Aaron Armbruster, DC

What is a chiropractic adjustment?

What is a chiropractic adjustment?

A chiropractic adjustment is a hands-on procedure performed by chiropractors to unlock stuck joints.  A chiropractor will first stretch the tight joint and then impart a quick, controlled force in the direction that the joint is stuck.  Often times, but not always, there will be a “pop” or “cracking” sounds associated with a stretch sensation.

What’s with the noise?

The noise that is produced is usually described as a “crack” or a “pop”.  The vast majority of movable joints are made up of two or more bones that are connected by ligaments thus creating a joint capsule which is full of a lubricating liquid.  When the joint and its capsule are stretched, the pressure within capsule decreases.  When the pressure decreases enough, gas that is normally dissolved within the lubricating liquid comes out of solution and forms a bubble within the joint.  The noise is believed to come from the instantaneous formation and collapse of the bubble.

The technical-jargon name for this sound is “cavitation”, based on the formation of a cavity (aka bubble) within a liquid due to a decrease in pressure.

How does a chiropractic adjustment work?  How does it help relieve pain? 

A chiropractic adjustment restores motion to areas of the spine that are “stuck” or not moving properly.  The human spine is made up of 26 independently moving vertebral bones and articulates with the two bones of the pelvis, 24 total ribs and the occipital bone of the skull.  For the entire spine to be functioning well as a unit, all of these components need to be moving smoothly.  By restoring proper spinal biomechanics, a chiropractic adjustment takes pressure off of tissues that are being injured or irritated by abnormalities in spinal motion, thus relieving pain.

Other theories have been put forth that describe how chiropractic adjustments can reduce and relieve pain such as the gate control theory of pain (read more here).

Is it safe?

Chiropractic is very safe.  So called “adverse events” or poor reactions to being adjusted are very rare.  The most common negative side effect of a chiropractic adjustment is mild soreness lasting a day or two, similar to what you might experience after a deep tissue massage or a workout at the gym.  Not only is current research demonstrating that chiropractic is safe, it is also outlines the effectiveness of chiropractic care.  For example, a recent study published in the journal Spine noted the following regarding workers injured on the job: “42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.”  This study is another example of the growing body of research indicating that chiropractors are a safe and effective treatment choice for back pain.

Strong Posture

Why is strong posture important?  

Let’s start with just one example.

Your head is too far forward as you strain to read some small text on your laptop.  Everyone does it, some are more guilty than others.  Now your head is not balanced on your neck and rest of the spine like it should be.  The muscles at the base of your skull, in your upper back and on top of your shoulders now have to work extra hard to keep your head from tumbling forward off of your neck and getting a concussion on the desk in front of you.

Think about it this way – Imagine a ten pound bowling ball (your head) balanced on the end of a broom stick (your neck), and you’re holding that broomstick a little ways below the bowling ball.  Now imagine angling that broomstick slightly forward so the bowling ball is not well balanced – it would be a LOT harder to hold, right?  Now imagine doing that for 40 hours a week, every week and consider how tiring that would be.  That’s a serious demand placed on the muscles that hold your head up!

No wonder so many desk workers have soreness in their necks, upper backs and shoulders – they’ve logged countless hundreds of hours with bad posture and now need to go see a chiropractor to start feeling better.  Wouldn’t it be easier to just better balance your head to start with?

Another angle on the importance of strong posture:  The effects of posture go beyond just what is seen and felt in our muscles and joints.  Strong posture sets a strong foundation for the functions of breathing and digestion by allowing for proper movement of the diaphragm.  The diaphragm is a muscle below the lungs that not only does the lion’s share of work for breathing, but also helps facilitate movement and digestion of food within the GI-tract.  Good breathing and good digestion are influenced by more than just posture, but practicing strong posture can at least give them a good foundation.

What does strong posture look like?

Here are the main components of strong sitting posture:

Head balanced on top of your neck.  Head not leaning forward, but balanced on your neck.  Usually this means consciously moving your head backwards.

Chin tucked.  Chin not poking forward, but tucked in towards your neck.  Not down towards your chest, but straight back, towards your neck.  If you do this right you’ll probably feel a slight stretch at the base of your skull.

Shoulders down and back.  Increase the space between your ears and shoulders.  Imagine that you’re trying to tuck your shoulder blades into your back pockets.  Pinch your shoulder blades together even more and you may feel a stretch in tight muscles in your chest.

Strong low back.  Move through a range of motion in your lumbar spine by arching your lower back away from the back of the chair and then flattening your whole low back against the back of the chair.  Find a comfortable middle between these two extremes of motion and engage the muscles in the front and back of your abdomen to support your spine where it is.  Use your core muscles to hold you up, don’t use the back of the chair as a crutch.

Knees in line.  Not splayed out to either side, but in line with the rest of your body.  Most often you’ll need to bring your towards one another to accomplish this.  Knees over your feet, feet flat on the floor.

Now that everything is in stronger alignment, imagine that there is a string connected to the very top of your head and it’s pulling you straight upwards.  Let it.  Notice how this straightens you up even further.  Now use your own muscles to do the work of that imaginary string, and keep them engaged to maintain your strong posture.

Strong posture may feel unnatural and may be tiring to maintain for any length of time.  If this is the case, you’re probably feeling the negative effects that weak posture has had on your body.  Your normal postural muscles are weak from lack of use and muscles that have been over-used are tight and sore.  If this is the case, or even if not, make an effort to start practicing strong posture and notice the results.  You may need to see your chiropractor to help you work through any muscle and joint imbalances and get you sitting more comfortably, feeling better and moving better.

Make a commitment to stronger posture; it is an easy step that can make a big difference!

Dan Suppnick, D.C.

Dr. Suppnick on Conservative Care:

Conservative care is the clinical practice of applying safe, and effective treatments before more invasive measures. Conservative care is and always has been a no-brainer to me. When choosing my career path, I knew I wanted to be an expert in conservative care and musculoskeletal pain – and chiropractic is the perfect combination of these two concepts.

The clinical concept of proper diagnosis is inextricably related to good conservative care. Without a full understanding of a clinical problem, at best an incomplete or temporary “band-aid” solution is all that can be achieved. As a chiropractor, I appreciate having a complete understanding of the body and it’s biomechanics to allow me to reach appropriate diagnoses. I also appreciate having a strong clinical education that allows me to identify when conservative care is not appropriate.

The other important component of conservative care is, of course, the application of conservative therapies. Chiropractic is a safe and effective conservative therapy for a wide variety of clinical conditions. As a practitioner I often to combine several different forms of treatment in order to address all components of a clinical case. Some of these include manual adjustments and mobilizations, soft tissue/fascial release, rehabilitation protocols, muscle strengthening and stretching and pain reducing electrical modalities.

Practicing conservative care as a chiropractor is always interesting, because no two patients are alike in their clinical picture. Teaching each patient about their specific case is something that I really enjoy. The teaching element is also essential in practicing good conservative care. An understanding of one’s own body allows for active participation in the healing process and provides strategies for future good health. The nature of my job reminds me daily of the amazing recuperative nature of the human body if proper conditions are present. I do my best to create the most favorable healing conditions for all of my patients.

Just as your car needs regular adjustments and TLC from time to time, your body benefits from “routine maintenance” as well. As we approach seasons of warmer weather and greater activity, it makes sense to prime our bodies for the increased movement and pressure we exert on our bones and muscles with the gardening, running, biking and other common spring and summer pursuits.

You wouldn’t think of letting your car go for more than six months without a tune-up, but it’s common to neglect our physical well being until we experience aches and pains. Much like automobile maintenance, your spine is more likely to stay healthy when you invest in regular chiropractic care, and your entire body will enjoy more vitality and experience less pain when you make time for monthly massages.

Several recent studies indicate that people who receive regular chiropractic care spend less money on their healthcare and report increased levels of happiness, health and mental well-being and lower incidences of injury and pain.

Tips for Staying Injury-Free

It may seem hard to believe now, but the time to enjoy sunshine and the great outdoors is right around the corner, so below are a few tips for keeping healthy and pain free while pursuing your favorite spring and summer pastimes.

Gardening

- Stretch your body thoroughly before starting.

- Avoid routine movements, which put you at risk for carpal tunnel.

- Alternate your stance from time to time and be mindful of your posture and movements, taking care not to strain and overextend muscles.

Biking

- Make sure your bike fits your body.

-  Set the saddle height so that your knee is slightly bent when the pedal is at its lowest position and the ball of your foot is on the pedal.

- Make sure your saddle is level; check this adjustment by using a level balanced on the saddle while the bike is on level ground. If your saddle tips too much in either direction, pressure will be placed on your arms, shoulders, and lower back.

- Always wear your helmet and make sure it is firmly secured. Helmets lower your risk of a head injury by 85 percent.

Walking

- Select shoes with plenty of cushioning in the soles to absorb impact.

- Walk briskly, with “purpose” to ensure that you’re getting a cardiovascular workout.

- When possible, walk on beaches, trails and other natural services with more give, which are easier on your joints (and usually offer more impressive views).

- Keep in mind that our local mountain, Mt. Tabor, has over four miles of hiking trails and now offers walking trail maps color-coded to coordinate with painted posts located throughout the park.

Visit Parkside Clinic Website

Massage and chiropractic care provide an immune system boost

If you haven’t gotten around to getting a flu shot (or even if you have) keep in mind that regular chiropractic and massage care keeps nasty cold and flu bugs at bay.

In fact, when hundreds of thousands of people succumbed to a virulent flu epidemic in 1918, the rate of chiropractic patients that contracted the flu was less than half that of non-chiropractic patients — not surprising considering that chiropractic care improves the function of the nervous system through improving the movement of the spinal bones that encase and protect the spinal cord.

Since then further studies have strengthened this connection. In 1991, Patricia Brennan, Ph.D. found better immune responses in her subjects following chiropractic treatment, including enhancement of the white-blood cells that search and destroy bacteria, viruses and dead or injured cells for the body.

Another study in 1994 by Sid Williams, DC of the Life Chiropractic University adjusted a group of HIV positive patients over a six-month period. They found that these patients had a 48% increase in important immune system cells while the control group experienced a decrease in these same cells.

Since improved well-being prevents the body from feeling the effects of stress, which compromises the immune system, chiropractic and massage care both protect the body from illness and fatigue. Massage further fights stress not only by enhancing our ability to relax. It also releases serotonin, which improves mood, and lowers the emission of cortisol, a natural steroid released when the body is tense that suppresses the immune system.

Determined not to get sick? Take your vitamins, eat right, exercise, get plenty of rest and commit to regular chiropractic and massage treatments.

Parkside Clinic Website

     Workplace injuries are a common and costly event in the United States.  The November newsletter has lots of information about these injuries and how effective and efficient chiropractic care can be in helping injured workers (and their employers!).  I want to write today about what to do if you have a workplace injury, and hopefully help clear up a usually confusing and sometimes frustrating occurrence. 

     First of all, how do you know if it’s a workplace injury, and if it is covered under Oregon workers compensation?  Sometimes it’s obvious- you are reaching for a stack of papers, you trip over that stool that you didn’t see, and every person in the store sees it happen.   However, sometimes it’s not so clear- what about  that numbness and tingling in your arm after several hours typing?  Is that a compensable condition for which treatment would be covered?

     The standard legal explanation is that if the symptoms (back pain, numbness, etc) is at least 51% due to an accident or the duties that you must perform at work, it is most often a covered claim.  In the obvious case above, if you were not having back pain until the fall and now you do, it is easy to conclude that the pain you are having is most likely a result of that unfortunate accident.  Things get a little more complicated in the second example, and a thorough history and examination by a physician would be required to get the diagnosis right and discern if this is a work condition or something else. 

     Which gets us to an important point:  where to go for help?  In Oregon, a worker may go to any licensed primary care physician or nurse practitioner to initiate their claim.  That means a medical doctor, and osteopath, a chiropractor or a naturopath.  At the initial visit one must fill out an 827 form, which initiates the claim from the doctor’s office.  One must also fill out an 801 form at your job, which notifies your employer that you have been injured and are seeing a physician for treatment.   Your doctor will decide if you need time off work and for how long, but your wages will only be covered by the insurance carrier if you miss 14 consecutive days.  Every employer is required to carry workers compensation insurance in Oregon.

    From here there are further loopholes that must be navigated, but the important thing that you as an injured worker must focus on is getting better and back on the job.  There is a lot of data out there that says the longer one stays off the job, the less likely you are to ever make it back.  So your employer may offer you “light duty”; a job that requires you to show up to work, but rather than running the jackhammer today, you’ll be filing papers.  This is sometimes appopropriate, but always depends on your condition.  Just follow the recommendations of your doctor, and take care of yourself so that you heal as well and as efficiently as possible.  You don’t want this to drag on and on.

     I see a lot of workers compensation patients, and we are always available to answer any questions that you may have when navigating in this difficult arena.  Many doctors wont  do worker’s compensation cases because of all the paperwork and administrative complexities.  But I have always felt that this limits the access that workers deserve to quality care, and we’ve got the process down cold.  So if you, or anyone you know, is having a work related problem, give us a call and come in to discuss your situation.   We are here to help!

Aaron Armbruster, DC, CCSP

One of the most common questions I receive in practice is whether to apply ice or heat to a painful area.  Luckily, the answer is very straightforward, and unlike some things in medicine and physiology, it is well understood why.

If you are unlucky enough to have a new, acute condition (ie; it just happened within the last 24-48 hours), ice is your best friend.  It is part of the acronym R.I.C.E.-  Rest, Ice, Compression and Elevation.  If you have injured your back or neck, it is often very difficult to perform all of these, so ice is the easiest and most effective thing you can do.  Ice is a natural analgesic, so it will help the pain.  More importantly, it slows the bodies natural reaction  to injury- inflammation. When inflammation runs uncontrolled, it can really slow down your healing time.  I’ll explain how ice a new acute injury below.

If you have problems of a more chronic nature, heat is a strong ally.  If an area of your body has been injured more than 48 hours ago, or if you have a persistent pattern of pain and dysfunction that has been diagnosed and heat is recommended, this type of therapy can be very helpful.  Heat relaxes tight and tender muscles, improves blood flow and exchange of nutrients, and generally feels good.  Moist heat is the best, but the most common form of heat found in stores are electric heating pads. 

So here are some simple instructions:

To ice:  Get a small re-usable gel pack, either from your local pharmacy or come by the clinic and I will give you one (for free!).  Place it in the freezer until it is completely cold (it will still be flexible).  Wrap the gel pack in a wet towel, and place the whole package on whatever area needs icing.  Avoid sensitive areas- placement should be restricted to muscles and joints.  Keep the ice on for no longer than 20 minutes.  And never place the ice pack directly on your skin- it will damage the tissues!  You can repeat the whole process one time every hour.

To heat:  If you have access to a moist hot pack unit, this is the best form of heat because it penetrates the tissues more deeply.  If this is the case, you need at least 6 layers of towels between your heat source and your skin.   Electric heating pads are OK, but be careful.  Keep the settings low, and never heat for more than 15 minutes.  Remember: don’t  take your heating pad to bed with you (fire danger!).  Once the area is warmed up a bit, you may find it easier to stretch, do some of your exercises, or do your normal activities with a bit more flexibility.

Wait- one more thing!  There is, of course, a grey area in this.  When you are healing from an acute condition, the inflammatory reaction only lasts about 48-72 hours.  There is a really cool trick you can do when the acute phase is ending (and you’ve been using ice) to help the tissues heal.  Alternating ice and heat is a fantastic way to help increase blood flow and speed your recovery.  Start with heat for 10 minutes, followed by ice for 10 minutes.  You can repeat this as long as necessary, with just one caveat:  finish with cold.

So many times I have heard a patient say “Well, I kind-of over did it in the garden this weekend.  I could tell I hurt my back, so I put some heat on it.  And, well, I fell asleep on my hot pack.  And I could not get out of bed this morning!”  Don’t let this be you!

We finally did it! After many long hours of compiling information and getting ourselves organized, Parksidepdx.com is up and running. We hope to use this site as a place where existing patients can go for information and news, and where people who are interested in coming in can come for a peek into who we are and what we do.
It has been dream of mine for many years to have a space like Parkside Clinic, and I am very proud of the people we have working here and the services we offer. Please have a look around the site, and feel free to comment on the things you see.
We are here to serve the Portland community with the most effective and efficient chiropractic and massage services available in a professional and comforable setting. If you are an existing patient, thank you for your continued support and for your great referrals. You are what keeps us going around here. If you are thinking of coming in and seeing us as a patient, please read what we have to offer, and call and make an appointment to come see us. We are here to help!

Aaron Armbruster, DC, CCSP