Expert: Dr. Victor Dolan, DC, DACBSP - 1/1/2010

Question
I have had x-rays and been told by an orthopedic doctor that I have a tilted pelvis which causes a knee rotation problem (turned outward).  Therefore I have tight muscle bands that create a leg length difference on the left side.  I was sent to Physical Therapy and it didn't help.  Recently I've been seeing a chiropractor twice a week (5 visits so far) and at first the adjustment was gentle and I felt great afterwards. However, the adjustments have become more aggressive and with pain and limited range of motion lasting the whole interim between visits.  He feels that I'm making progress because the pain has moved to one area (hip and low back) instead of being referred down to the knee and calf area and tingling in left arm as well.  I can't bend,squat, walk or stand very long without very sharp pain throughout the hip. Since I have a chronic condition what should I expect (certainly not full recovery) from ongoing visits.  Thank you so much.    Joan

Answer
Chiropractic, Chiropractor, Doctor of Chiropractic, Chiropractic Specialties, Adjustment, Chiropractic Adjustment, Chiropractic Manipulation, Staten Island Chiropractic, Staten Island Chiropractor, Pain, Pain after adjustment, Chronic problem, pain vs soreness,




Hello Joan,

I am sorry to hear of your problem, sorry to hear of a slow, complicated recovery.


".....I have had x-rays and been told by an orthopedic doctor that I have a tilted pelvis which causes a knee rotation problem (turned outward)......"; interesting!- did you initially go to the Orthopedist for a lower back/ hip complaint?, or did you go to the ortho for the knee complaint?
         Women do have increased knee problems due to a wider pelvis, an increased 'Q' angle compared to men.  Often doctors of all disciplines get 'tunnel vision' and only look at the chief complaint- the painful spot, and do not look elsewhere for the cause of the painful symptom.  I am glad your Orthopedic is taking a 'whole body' approach- ie: looking at your entire 'lower half' for the cause of your complaints.
         This 'tilted pelvis',,, to a Doctor of Chiropractic it begins to sound like a mis-alignment, a 'subluxation' in chiropractic parlance.  The Xrays / imaging studies (MRI, CT) do not show any osseous anomalies (any bony peculiarities)?- The Orthopedic MD and the Chiropractic Doctor would both review your films and tell you if there were.  If there are no bony abnormalities, then we get into correctable mis or mal-alignments.

In the Chiropractic world- correctable misalignments are called 'subluxations'.  These subluxations can occur in the spinal joints, hence called Vertebral Subluxation or the Vertebral Subluxation Complex.  Chiropractors attempt to reduce or correct the subluxation via manipulation, hence the Chiropractic Adjustment.

There must be a thousand different Chiropractic Techniques out there, with tens of thousands of different adjustment maneuvers.  Some adjustment techniques are quite vigorous, some techniques require very low or no force.  Most Doctors have several Chiropractic Adjustment Techniques available to them.  Depending upon the patient; height/ weight/ age/ sex/ health/ complaint/ history/ RESPONSE to treatment/ etc/ etc, the Doctor can change and tailor the Chiropractic approach.

You have communicated to me,,,, have you communicated to your treating doctor that his(her) adjustment technique gives you pain?

Ahhh, this is also a question; is the technique causing you 'pain' or 'soreness'.  An adjustment should cause little or no pain.  An adjustment regimen- being treated for a couple of weeks or more, being adjusted 1, 2, 3X per week over a few weeks; should not really cause any 'pain'.  The body adapts, the body 'gets used to' the things we do.  Perhaps if you exercise you have noted post-exercise soreness-- this is expected.  Post-exercise PAIN however shows that you have exercised incorrectly= either too much exercise, or improper technique.
         Chiropractic may cause you 'soreness' as an exercise regimen could.  Chiropractic should not cause you 'pain'.  You must define what you are feeling.  If it is pain, you should communicate this to your Doctor.  There are many different techniques available, and your DC should have a choice of several.  If 'Gonstead Technique' causes you pain, then perhaps S.O.T. Technique should be tried; if S.O.T. causes pain- then perhaps Gonstead should be tried.
         A change in technique is warranted if the current technique causes you pain.  TALK to your treating doctor.

"....Therefore I have tight muscle bands that create a leg length difference on the left side.  I was sent to Physical Therapy and it didn't help.....", as a Doctor of Chiropractic, I will admit my bias towards CHIROPRACTIC treatment for many complaints.  That CHIROPRACTIC treatment would include Chiropractic Adjustment- whether by a vigorous adjustment, or a low- no force adjustment; AND adjunctive physiotherapy.  Physiotherapy utilized in my Staten Island Chiropractic office includes infrasound, ultrasound, electrical trigger point therapy, interferential therapy, electrical muscle stimulation, exercise, hot, cold, stretching, traction, decompression.
         Many Chiropractic Doctors have offices similar to mine- we have a lot of 'toys' (therapy equipment) which we utilize depending upon the patient and complaint.
         I am partial towards Chiropractic because we seem to treat the MANY aspects of a problem: muscular imbalance, joint misalignment, neurological involvement, nutrition, etc etc.
The most important of which seems to be the joint dysfunction- from there the many other issues flow.

This Staten Island Chiropractor hands out information to my patients to let them understand what our goal is, here is a sheet I distribute:




‘VSC’-  
the    Vertebral  Subluxation  Complex     
(aka:  the  “Subluxation”)

Many times a patient will come to the Doctor of Chiropractic – ‘…as a last resort…’,  often  after  ‘….everything else has been tried….’.  This is frustrating to the Doctor (the DC),  yet also satisfying.  Frustrating?, Satisfying?, ,,,why?-  Many times a symptom, an ache a pain, a condition can be caused by the ‘Subluxation’ – the ‘Chiropractic Lesion’.  Just as germs, the Virus or Bacteria- is the ‘medical lesion’ (- the MD looks for germs, the DC looks for subluxation).   Many times an unexplained condition, after exam after exam, blood tests, Xray, MRI, EKG, EMG, etc., etc., --- Chiropractic can help the patient.  Why??- because only a Doctor of Chiropractic will check for subluxation- as well as run the ‘traditional’ tests.



           Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.



The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


Subluxation  is  a  serious  condition  identified  by  its  five  parts:

            Spinal Kinesiopathology:        This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

            Neuropathophysiology:         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

            Myopathology:           Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

            Histopathology:       A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

            Pathophysiology:     The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine


If your pelvis/ lumbo-pelvic junction/ hips , if you knees are 'subluxated', a joint manipulation as well as muscular therapy is probably in order.

"....I was sent to Physical Therapy and it didn't help.....", the PT sometimes does not address the MANY aspects of the problem.  Usually most DCs address the many components of the problem.

"....Recently I've been seeing a chiropractor twice a week (5 visits so far) and at first the adjustment was gentle and I felt great afterwards. However, the adjustments have become more aggressive and with pain and limited range of motion lasting the whole interim between visits....",  did the Doctor change his(her) treatment approach from one visit to the next?
Have you communicated this complaint to the Doctor?  Is it pain or soreness?
         As discussed, soreness- if not extreme- can be expected with the changes going on in the body.  For several years I had a sore mouth- - - - I wore braces to move my teeth, and when I was a teenager, my mouth, my teeth hurt like heck with the braces pulling my teeth to their proper positions.  Pain?,,, pain must be communicated to your doctor.  Pain?,,, the doctor should re-evaluate the technique, there are many choices in our armamentarium.

"....He feels that I'm making progress because the pain has moved to one area (hip and low back) instead of being referred down to the knee and calf area and tingling in left arm as well....",
Range of motion should be improving, function should be improving, initial symptoms should be decreasing, BUT 'Pain" should not be increasing.  Talk- Communicate- you are concerned enough to write me, be concerned enough to tell him!  A change in technique is available!

"....He feels that I'm making progress because the pain has moved to one area (hip and low back) instead of being referred down to the knee and calf area and tingling in left arm as well....",
Chiropractic, as with many 'physical medicine' techniques takes time.  Physical Therapy will often see a low back pain patient, or neck pain, or shoulder or knee pain patient for 2- 3 visits per week, sometimes for 3- 4- 5- 6 MONTHS.
         I wore braces on my teeth for YEARS to move those teeth (bones) and train them to stay in their proper position.
         People exercise DAILY for many YEARS, and do not wind up looking like Jack LaLanne or Arnold Schwarnegger (spell??).
         Changes in the body can take time, can be slow.  One way we note changes is the change in symptoms; if your complaints are shrinking,,, the problem is getting better, and treatment is helping!

".....I can't bend,squat, walk or stand very long without very sharp pain throughout the hip.....", these complaints,,,, were they there at the START of treatment?, are these complaints new??  If these complaints are new- COMMUNICATE with your treating doctor!!!
         If these complaints are what you came in with,,, they may take weeks to months to improve.  Physical Medicine takes time.


Again, in my Staten Island Chiropractic office I give out this informational sheet to explain the expected progress:



Treatment Regimen:
Why  so  many  treatment visits ?,   Why so many different  therapies ??

Many people do not come to the Doctor of Chiropractic first.  Many people take an over the counter medication (OTC) (covers up the pain, does not treat the cause of the pain),  see a medical doctor for a prescription medication  (covers up the pain, does not treat the cause of the pain, stronger then OTC drugs, increased possibility of side effects and complications), or just wait and hope the pain goes away.

                        Then, after the pain continues, FINALLY they go to the Doctor of Chiropractic.  Studies show that while Chiropractic is often the last Doctor people will go see, they expect immediate results- i.e.; a couple of weeks of treatments are expected to cure the problem.  It is a paradox that people WAIT to go to the Doctor of Chiropractic, but expect immediate results, on conditions that have been building for months or years; yet when they go to a medical doctor- they accept invasive surgeries  and/ or a long treatment protocol of physical therapy- weeks, often months.

                         Spinal pain, like many other conditions, often builds for years and years until the pain becomes strong enough to send someone for treatment.  It is well known that heart conditions build for years and years, yet  in  40% of cases, the first pain someone feels with their heart,,,, is the last pain someone feels with their heart (a fatal heart attack in ‘asymptomatic’ patients).  Sad that they waited for pain to be a gauge of health.  Pain is the LAST thing that comes in a problem, and often the FIRST symptom to go away.  If there is a problem, isn’t it better to treat BEFORE the pain, or if pain has started, isn’t it better to take care of the problem, prevent future pain and progression of the condition?

                         Why so many treatment visits to start?,  Well the problem, the condition, has momentum on it’s side.  Irritation, inflammation and damage has taken place and then the pain comes.  Pain is the last thing that comes in the condition, and Pain is the first thing that disappears during treatment;  but the underlying irritation, inflammation and damage has to be repaired. Initial treatment schedules, depending upon the severity of the complaint could be as often as twice per day, or once per day for two- three weeks, followed by a gradual reduction in treatment visits.   This is similar to surgery!  When a patient has an invasive surgery, often there is followup rehab treatment of daily, then every other day, then weekly visits for a prolonged period (i.e.; shoulders- up to a year of treatment AFTER invasive surgery).

                         Chiropractic works with your body.  Chiropractic helps your body to heal itself. Chiropractic restores Homeostasis, balance in the body.  Chiropractic  corrects  the  Vertebral  Subluxation  Complex.  You  cannot be ‘healthy’ if you have a Subluxation.  You MAY feel it, with a pain, stiffness, or a ‘kink’ in your neck/ back.  You may NOT  even feel it-  just as people often do not feel the cavity growing in their tooth,,,, until it hits the nerve; or you may not feel it at all, like people do not feel high blood pressure or diabetes until AFTER damage has been done!!  The vertebral subluxation complex can be the underlying cause of many healthcare problems.  A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates  all   function  within  the  body)  and may cause various other conditions,  symptoms and problems.  This  (Subluxation)  is a serious condition identified by its five parts:    Spinal Kinesiopathology,     Neuropathophysiology,     Myopathology,  
Histopathology,    Pathophysiology.    Chiropractic corrects this ‘silent’ condition, works WITH your body, and like other health approaches requires a certain treatment regimen and a period of  TIME.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine


If you are having 'soreness', this is expected.  If you are having 'pain' this is not expected. Talk with your doctor.

If this has been a chronic condition- progressing for months or even years,,, you must give the treatment time to make a corrective change in your body.

As you can see--- I love giving out explanatory information in my practice to my Staten Island Chiropractic patients, again a handout:




                                  Treatment   Regimen

Why do I need to have treatment __________________ ? ! ??
( TWICE A DAY,  EVERY DAY,  3- 4x/week, 2- 3x/week, 1- 2x/week )     Depending upon your specific condition, your specific case, you may need to be seen many times in a short period.  If your condition is severe, complicated, particularly painful; you may need close, frequent attention.  Similar to medicine, usually the more severe the case the more often medicine is taken with larger doses.  The Doctor of Chiropractic works with hands and therapy in person to accomplish the goal, the MD can treat ‘long distance’ via medicine without actually seeing the patient for treatment.

Why do I need to have treatment for  (weeks,  months,  years!?! )  ?
Again, the Doctor using chiropractic techniques needs to get ‘hands on’ in person.   An MD can treat a patient without actually physically seeing the patient every day through medicine;  i.e.:   “…Here are 60 pills, take one a day every day, and I will see you in two months…”.   The dentist can say- “…here, wear these braces 24 hours a day, 7 days a week, for the next two- three years.  I will see you every two weeks, but I’ll be treating you every day, 7 days a week, 24 hours a day for the next few years…” .

People can wear braces and retainers for YEARS.  It can take YEARS to move the bones (known as teeth) into their proper position.  It can take years and years, and thousands of dollars !  But, those teeth (bones) have to be properly aligned to have a nice smile.  BUT you do not have to keep wearing the brace or retainer, you can take the brace off any time,,,, and let the teeth go back to their misaligned positions (habit).

Some people with certain conditions have to take a medicine every day, seven days a week, 365 days a year;  “…..for the rest of their life….” .   Sometimes someone can have a damaged heart, lung, liver, kidney, pancreas;   and they have to take a medicine, sometimes a FEW medicines, every day, sometimes for years,  sometimes “…for the rest of their life…” .   Similarly, a damaged neck or back, a damaged spine, a damaged nervous system can sometimes use treatment  “...for the rest of their life…” .

Most people who go to the Doctor of Chiropractic feel a difference in their pain in as little as two or three weeks.  Instead of taking years (like braces and the teeth) to make changes, the dynamic spine can start to feel better very quickly.  To maintain the proper position and movement of the vertebrae (bones) it can take a continued regimen of care (of course not as frequent as the initial schedule, but to maintain gains, maintenance has to be performed).  BUT you do not have to keep up with treatment, you can stop any time you want,,,, and let the vertebrae go back to their misaligned positions (habit).

It  is  a  joke  amongst  Chiropractors  that  the  DC  is  a  magician-  first  Chiropractic  makes  the  pain disappear,  and  then  the  patient  disappears  as  well !!,  BUT-  pain  is  the  last  thing  that  comes in  a  problem,  and  the  first  thing  that  disappears  under  treatment,,,,   but the disappearance of pain  does  NOT  mean  complete  correction  of  the  underlying  health  problem.


Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine


Finally a word of caution on pain medications.  Your Doctor of Chiropractic should be reducing your pain complaints.  Your DC should not be causing you to take pain medications- here is some recent research upon pain medications-  be cautious:




Pain  Killing  medication???  =    16,000  deaths   ( probably  under-reported )
                         DEATH ! ? ! ?    better   watch  out  on  those  medications!!!  

PAIN           
Pain  is a  ‘red light on the dashboard’.  
Pain  is  your  body  telling  you  that  something  is  wrong.   
Think  you  should  listen??
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  
Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   
Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?


                             NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to  include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468   Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001)  Motrin, Advil = NSAIDS

The  American Heart Association issued a scientific statement   recommending medical doctors change the way they prescribe OTC pain relievers from a first choice    to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ).   Many times people take NSAIDS  for  the pain of Arthritis,  not realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.
              A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.



"....Since I have a chronic condition what should I expect (certainly not full recovery) from ongoing visits.....", a chronic condition is certainly more difficult to resolve.
         We must define 'chronic'; does this mean weeks?, months, years, decades?  Certainly decades will not fully resolve, but if treatment allows a greater return towards health, at some point would not maintenance pr preventive treatment be appropriate- and ongoing?
         Years of chronicity?- again FULL resolution may be impossible, but with each treatment a small incremental improvement may be made.  The body is ALWAYS changing, either changing for the better or worse.
         Months of chronicity?- know what?,,, full return or darn close to full return may be possible.


I hope all of this reading material has helped.
TALK to your doctor about PAIN.
CHANGE in treatment technique is available.

At this time of year--- wishing you a Happy and HEALTHIER New Year!

Thanks for the question, if further information is needed, please re-contact me here at
ALL Experts !

Dr. Victor Dolan, DC
Email Newsletter:. . . . .drvictordolan.chiroweb.com