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PostPosted: Wed Jul 22, 2009 1:26 pm 
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KPJ bring ups a good point with the physical therapist. Another problem with a chiro is people might go to one and not go to a PT, which is probably what they need. That's my biggest problem with alternative medicine, that people may not go to a real doctor until it's too late.


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PostPosted: Wed Jul 22, 2009 4:20 pm 
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Tim--I'd be glad to add to the confusion! Kenny's statistics are interesting, and help me avoid less-specific statements. And that is the problem. If we could say that bulges are all pathologic and that every bulge should be fixed, and that fixing them would always solve the problems, the world would be a better place, at least for back-pain sufferers and spinal surgeons. But many people who have no real problems have bulges. Bulges in and of themselves are not pathological, and usually should be ignored.

So let's say that you have a bulge in 1 or 2 discs, and that they have been there for many years, you just don't know it. You develop back pain for who knows what reason. Ligaments strained, muscles pulled, arthritis in a facet joint, etc., due to bad posture, overweight, lack of exercise, strain, sprain, or whatever. You go to the doc, who sends you off for an MRI (because if he or she missed something important, they could be sued, and so they don't want to trust the fact that nothing in your physical exam suggests that you have anything worse than a strain). The MRI shows the bulging discs, so your doc refers you to the local spinal surgeon, who has just grown tired of his Porsche, and is thinking Maserati (no they aren't all greedy villains, but hey, let's pick on them for now), who offers to operate and relieve you of the bulges, and your insurance company of a few grand. What do you do? Most people don't see an alternative. Surgery goes well, and you fee better for a few months, but as you get back to work at your desk job, away from PT, etc. the pain recurs.

Here's how I would proceed if it were me. First, determine if there are significant neurological symptoms or findings. If there is a focal weakness (specific muscle groups are significantly weaker than the others, and this is almost always asymmetrical, since it's hard for a bulge to affect nerve roots on both sides equally) or a sensory loss (significant change in sensation) in specific skin areas, or decreases in tendon reflexes, then I'd want the MRI. If not, I'd change my exercise patterns to try to reduce the pain. That interview with Brian Nelson is applicable here. He uses strength training for almost any kind of back pain (except cancer, of course, or cases with compelling clear indications for surgery). I think he uses hyperextensions as his primary modality.

If there were significant neurological symptoms or findings, AND the MRI showed that the bulge was in contact with the particular nerve roots that provide the function that is abnormal, if pain was severe, and if exercise was not helping, THEN I'd consider surgery. If you have a symptom that is attributable to the L5 nerve root, but your bulge is on L3, surgery can only make you worse. Most reputable spinal surgeons will only operate under the conditions I have outlined. I'd also seek 2 or 3 opinions before proceeding to surgery. This is a big operation, recovery is long and difficult, complications can be devastating, so I would never do it lightly, and neither would a good surgeon.

I don't know about Louie Simmon's reverse hyper machine. What is it like? Does he feel that reverse hypers are more effective than conventional hyperextensions?

I don't have time to discuss the placebo effect of surgery. You think a pretty green pill can have a big placebo effect? Nothing to the powerful placebo that is potential in surgery. There are several cases of proven placebo effect. So just the fact that some people feel better after an operation doesn't prove that the operation benefited them physiologically. Material for another rant at another time.


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PostPosted: Wed Jul 22, 2009 6:46 pm 
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Jungledoc wrote:
Peter, think what would have happened if your chiros had manipulated you, and then you had not done anything differently in regard to your exercise. Do you think the results would have been as good or as long lasting?


No, they wouldn't, in either case. Much like how my strength training, although pretty much on-target, wasn't enough on its own, either. I needed a combination of both.

What's interesting to me is that I saw two chiros for the same hip/shoulder alignment issue and subluxated SI joint. Both told me the same thing - they'd need to adjust me, it would take a number of visits to get it fully back to where it should be, and that I'd need to do exercises to strengthen the muscles in those areas to ensure it would last. Both would have referred me to a physical therapist, but I told them I had a professional strength coach, so they just gave me advice on what to include and avoid. Sadly, "avoid squats and loading the spine until your back heals" was in there, but they were right, I needed to do that.

Short version - adjustment + reverse hypers did a lot more than just strength training had on its own. And than adjustments on their own.

I occasionally get treatment now from a third chiro, a friend who does MMA with me. She's given me ART but also proscribed stretches and exercises to ensure I correct the root problem.

I eventually turned to these DCs quite by accident...I went to a general sports medicine center and they put me in the room with a DC instead of an orthopedist or anyone else. The various DCs I dealt with were the first medical folks I'd dealt with who really integrated the care together - exercise, stretching/mobility, rest, and soft tissue work/adjustment - into one whole.

This is why you don't see "chiro adjustment" very often in my journal. We worked out the acute injuries, worked on the long-term ones, and I reinforced the results in the weight room and in my daily living.


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PostPosted: Wed Jul 22, 2009 6:50 pm 
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TimD wrote:
The reason I'm asking, is because I read Louie Simmons of Westside suffered from one, and used reverse hypers as part of his treatment, and atually designed a reverse hyper bench/machine for this purpose.


I'm not Jungledoc, but the reverse hyper was the best thing ever after I hurt my back in MMA class. I actually requested extra sets on it once or twice on upper-body focused worked days because it helped my back so much. It was eye-opening, how good it felt and how effective it was as rehab.


Doc - here is all you'll probably need to know about the reverse hyper:
http://www.elitefts.com/documents/reversehyper.htm

And this is a pretty good video explanation.
http://www.youtube.com/watch?v=vAu4CRSKrPQ

You'll find people doing these on tables or on a glute-ham raise apparatus, too.


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PostPosted: Mon Sep 07, 2009 9:21 am 
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Was reading MIke Robertsons latest news letter and it reminded me of this thread. He writes about the reverse hyper with regards to rehabilitating lower backs. Quite interesting.

http://robertsontrainingsystems.com/new ... h%2C+2009/

KPj


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PostPosted: Tue Sep 22, 2009 4:12 pm 
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I go to a chiropractor. The first one I ever been to sucked and wanted me to go 3 times a week, said I have scoliosis (which I do not) and just wants my money. I did not feel better at all going to him and all he says is that it just takes time.

The 2nd one I have been to (recommended by my pilates teacher I had a few semesters ago and also the dance teacher I am taking now to learn how to dance goes to him too and says he works on a lot of dancers, sports injuries, and anyone in general). When I first took the pilates class (to improve my core strength & flexibility), my teacher said I had bad posture and recommended me to go see a chiropractor and gave me the card to go see him. First I went to the guy I explained above that sucked that is close to me and then I was like ok..I gotta go see this guy even if its 30 minutes away because of great reviews, and I am glad I did. I had twisted hips, neck pain, low back pain, hunched up/forward shoulders, etc. After 1 session, it was all fixed. No more back pain or neck pain...but I had trouble keeping my hips from getting twisted at first due to poor habits, but I have no problem now. I only see the chiropractor when I have a problem due to playing a sport or whatever. I went friday for my ankle, and its good now except that the strength & mobility is not 100% like it was yet. working on it. this guy works full body, from head to toe to the fingers.

not all chiropractors are good, but some are. I am thinking about trying an ART person 2 miles from my house to get rid of the knots in my trap muscles that is tight in a lot of people. ART is more successful than a massage place.

anyone ever had ART?


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PostPosted: Thu Sep 24, 2009 5:29 am 
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I would love to try ART but there's no ART guys close to me. Closest place is London, which is just a short trip to the opposite end of the UK for me. I actually drove almost that far to go to a Cressey Shoulder Seminar ac ouple of years ago but wouldn't do it for one ART session!

I would recommend going for it. One session won't kill you. One of the things that makes a physio or chiro good is being able to do soft tissue work. ART is soft tissue work. It would be interesting to hear what they had to say about you vs what the chiro says.

KPj


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