My Epiphany- The Making of a Pearl-Days 8-11

Monday, July 25th, 2011 At 9:29 pm

Did you know, before the time of cultured pearls, natural pearls, also known as “the Queen of Gems”,  were so rare, they were reserved for only the very rich and powerful.  It has been reported that the value of just one natural pearl earring was enough to finance a Roman military campaign.  Even today, with the abundance of pearls from farming or “cultured” pearls, a natural pearl necklace can fetch hundreds of thousands of dollars.  This information alone was not an epiphany, nor was it at all new.  But thanks to Father Dobbins’ sermon this weekend, I learned a little more about what it takes to make a pearl.  This information changed my outlook on my injury, and to some degree, my life.

The creation of a pearl is actually an immune response from a mollusk.  These particular species of oyster, mussel, or clam secrete a fluid around an irritant, such as a piece of sand.  This defense mechanism of secretion forms layer upon layer around the irritant until a lustrous pearl is formed.  This irritant, or wound, is similar to my fractured elbow and torn ligaments; and the secretion, is similar to the inflammation.  A beautiful and rare pearl is formed from an irratant.

This simple story, told by a man I greatly respect, had particular meaning for me that day.  The wound I received, and the difficulty it has caused, has turned into a blessing.  Things that I took for granted, such as being able to brush my teeth, eat my food, and play with my children, have been either taken away or made more difficult.  I realize how lucky I am and how much I loved doing those things.

I also had a re-affirmation of what I do for a living.  I love being a Chiropractor and helping people recover from their injuries.  It is easy to get caught up in the day-to-day monotony of paperwork, insurance companies, and other mundane tasks.  At that moment I realized that the mundane tasks are a small price to pay for all the things I enjoy, but have taken for granted.  I look forward to my return.

So what has transpired since last Thursday?  I received three more treatments.  Dr. Ricci adjusted my neck and mid-back to reduce the restriction I had been experiencing.  The adjustments have helped my neck pain and that rib pain tremendously.  My neck pain is currently at a 0/10.  My range of motion in my neck and mid-back is back to normal.  I still have some stiffness around the rib-cage but the sharp pains are gone.  I also had a 1 hour massage on my neck, back and arm.  The combination of better spinal mobility, along with the benefits of massage for circulation and muscle function, have directly improved my elbow.  To see this relationship you must understand what the adjustment of the spine is and what it does for extremity injuries.

According to the World Chiropractic Alliance,

The Goal of the Adjustment:

The goal of a chiropractic adjustment is to correct the spinal subluxations detected during the examination. To do that, the doctor applies pressure to the bone and “unlocks” it from its improper position. The bone will then be free to align itself correctly.

Unfortunately, the muscles connected to subluxated vertebrae get used to their positions and have a tendency to pull the bone back out of place. It may take several adjustments before the adjustment “holds,” and the bone settles into its proper alignment.

So when my neck and mid back were adjusted, it allows for normal range of motion.  This allows for better posture and movement for all the muscles that travel from my back to my shoulder.  This in turn allows for better movement of my shoulder and arm, thus taking stress off of the healing bones, muscles and tendons.

In my career I have seen neck and back adjustment relieve pain in the arms, wrists, knees and ankles of my patients due to this direct relationship.  My bone and soft tissue still have to heal.  But I am allowing them to heal at maximum capacity because I am treating the whole body rather than just the injury itself. I have also increased my vitamin C and water intake.

As for the elbow, it still hurts, and is still very weak.  The swelling is almost completely gone, and my range of motion is still slightly restricted.  All things considered, it has only been 11 days out of the 6-8 weeks it generally takes for these things.  My aggressive therapy seems to be paying off.  I have done Ultrasound, Electrical Stimulation, and both passive and active exercise on the injured side.  I have also increased my exercise on my uninjured arm as there is a small neurological stimulation to the affected side.

Pain: 2/10 spikes 7/10

Swelling: Mild

Prognosis: Good

Next time I will discuss how a good therapist must address more than just exercise and the benefits of myofascial therapy.

Days 5 through 7- My Aching Back

Thursday, July 21st, 2011 At 3:08 pm

Sleeping is the one thing I am innately good at.  Older brothers and sisters (6 of them) who are uninterested in nap-time; bus rides to the early morning high school football games packed with donut-eating sugar crazed teammates; alcohol induced college all-nighters; and crying newborns at 2 AM, wanting something that was impossible to figure out; none of it mattered.  I can sleep through anything.  My wife would be irately jealous of my ability to be thousands of miles away in dreamland within moment of my head hitting the pillow.  But this elbow!!!  It is waking me every few hours.  If I didn’t know better, I would think the amazing wife is accidentally hitting my arm as payback for those nights I slept through the screaming child.  Coincidentally, I did painfully awake a few more times the night after my wife mowed the lawn.  But, I digress.

I saw the orthopedist again on Tuesday.  He still feels confident that no intervention is necessary and to continue as planned.  He warned me to be careful and not overdo it, so as not to re-injure the already mangled ligaments and tendons.  I injured both collateral ligaments.  The medial (closest to the body) better known as “Tommy John Injury” is very tender and bruised.  I guess my childhood dream of playing third base for the New York Yankees, and diving for that game saving catch in a Craig Nettles’ fashion, is finally over.

The orthopedist’s advice is very important at this point.  Since I do not have the elbow braced, it is very easy to over-do it.  I also have to move like an NFL halfback to avoid all those who unknowingly bump into the injured wing.  Not an easy task at my son’s swim meet.  Any injury is very weak and painful in those first 2 to 3 weeks.  Remember, the body is laying down new collagen that is disorganized, weak and tender to the touch.

I was so concerned about my elbow, that I was able to forget the fact my neck and back were impacted.  Remember that “tuck and roll”?  Well the tuck went well, but I seemed to have rolled heavy over my mid back injuring an attachment of one of my ribs and jamming a few of my thoracic vertebra.  Essentially, where the rib attaches to the vertebra there is a cartiliginous attachment that is sprained and subluxed.  It causes muscle spasm and makes it difficult to breathe.  When I try to inhale I get a sharp pain between my ribs that is very uncomfortable.

I have seen a lot of patients with this problem and I now have a better appreciation for their pain.  The Chiropractic adjustment is an extremely effective treatment for this condition, followed by effective exercise to keep it mobile and stabilized for the long run.  This is a good example of the synergy between Chiropractic and Physical Therapy and why the multi-discipline approach, such as we have at Capitol Rehab, is so effective.

So what is my plan for the next week?

I will seek care every other day.  So Tuesday, Thursday, Saturday of this week, and Monday, Wednesday, Friday of next week.  Care will consist of adjustments by Dr. Ricci on the sore Cervical and Thoracic spine as well as that subluxed rib head.  Followed by Electrical Stimulation and Ultrasound on the elbow, and myofascial release (light massage).  Finishing with some pain-free passive and active exercise.

I had my first adjustment on Tuesday and feel much better.  The rib is still an issue and will most likely take a few weeks to stabilize with the adjustments.  I will take each one of the therapies and explain what it is and  why each one is important.  Tomorrow I will discuss the adjustment.  Fridays Topic will be the benefits of soft tissue work such as Massage and Myofascial Release.

Days 5-7

Pain:  4/10 Spikes 7/10

Swelling:  Moderate

Prognosis:  Guarded

Tomorrow’s Topic: Forget what you have heard.  What is a Chiropractic Adjustment and how can it help in your recovery.

My Broken Arm

Tuesday, July 19th, 2011 At 12:52 pm

I was feeling so good that I decided to extend my normal bike workout form 2-3 laps to 5. My energy was so good I  decided to extend my course to also include a yet uncharted trail. Do you know when you are about to do something, and you hear that little voice whispering in your ear? This little voice was screaming at the top of its lungs, STOP!!!! But my energy and ego completely ignored the little guy who seemed to say to himself, “OK don’t listen to me, I am only omniscient”.

So instead, I increased my speed. I turned a sharp corner to see the trail as it takes a 90 degree turn. Essentially, I was running out of road but had plenty of speed. So reality hits. The svelte 25-year old triathlete, with cat-like reflexes I envisioned, transforms back to a 43-year old with the reflexes of a speedy snail.  My choice was to take a header into a tree or brake hard and do an awkward flip over the handlebars. I choose the latter. So here I am flying through the air like Wile E. Coyote after the Road Runner has removed the ACME rocket from beneath his legs. I land on my extended right arm and attempt a “graceful” tuck and roll. (Let’s just go with it for now).

I stood up and said to myself, I think I am alright. The only difference now is that little voice is now loud and clear. I have been treating orthopedic injuries for 15 years and I know what I probably did. You cannot catapult 210 lbs up into the air, and come down stiff-armed without some injury. I also felt the compression in my elbow and shoulder. I just hoped the damage was not a displaced fracture that would require a long term cast. I also know I should not try to diagnose myself.

So, to jump ahead a day, it turns out I have a compression fracture of my radial head (elbow) as well as excessive swelling in the elbow joint.  And a lot of soft tissue damage.  I also have a mild whiplash and a subluxed rib head. So much for the graceful tuck and roll.

I have decided to blog this event for the benefit of my patients. To share my experiences.  I want to document how I manage my injury and the benefits of rehabilitation through the stages of recovery. I will try to cover the most frequently asked questions such as; when to ice and when to heat, do I need an MRI? How long should I expect recovery to take? When do I start exercise? Should I brace or cast or not at all?

I welcome any questions you may have, and will keep you informed on a daily basis. Tomorrow, I will break down the first week from what I did immediately after the wreck, to my visit to the orthopedist today. I hope you find it interesting and I look forward to getting back to 100%.

John Doepper DC

Why Didn’t Physical Therapy Help?

Monday, March 15th, 2010 At 2:14 pm

I would like to answer this question with a case history. I was treating an ultra-marathoner who was preparing for his 10th 50 mile race. It was a big deal for him as 10 is a *big* milestone (understandably, not too many people have run 50 miles, no less have done it 10 times!).

A bad case of plantar fascitis!

The ultra-marathoner had a bad case of plantar fascitis. In an attempt to attain his goal, he ventured down a quest to find the cure for his condition. His quest started at numerous sports medicine doctors, months of physical therapy at 2 different locations and treatment by his chiropractor. Each one addressed a different aspect of his condition.

Here is how it went:

• The MD gave him NSAIDS and also use an injection of corticosteroids. This gave him temporary relief but when he went back to his routine it came back.
• Because of his determination he read how chiropractic may help. So his quest led him to so-called alternative medicine. This next stop was to his chiropractor who manipulated his pelvis and hip. The chiropractor explained this was causing an abnormal gait pattern (how you walk and run) which affected how he was landing on his foot. His chiropractor also gave him some custom orthotics to help with an over-pronation of his foot.
• The adjustments did not seem to help (although they gave him relief of some low back pain he was experiencing) and the orthotics seemed to aggravate his feet. Increasing foot pain was not the reason for this visit so the quest continued.
• His doctor then sent him to a popular physical therapy clinic. This was a busy operation and what we call a PT mill. He was brought in as a number and run through the conveyor line.
• After 8 weeks of ultrasound, stretches, band exercises and told to ice at home he was losing hope. The ultrasound and ice helped a bit, but the calf stretches seemed to hurt so he stopped.
• Next stop, a physical therapist (PT) that was recommended by another runner. The PT was also a runner so this gave him some comfort. The program there was better. The PT spent one on one time , did some “massage on the fascia” that seemed to help and reviewed some stretching and even focused on a balance routine. He was improving quite well, but each time he tried to run, it would come back.
• The PT advised no running! This advice is almost impossible for any runner to comply with but the ultra-marathoner was desperate.
• After a few months he was better. He was ready to start training again. The race was getting closer only a few months out. After a few weeks though, the pain returned. He decided he would just run through the pain. He would finish this race if it killed him.

Still determined…

Still determined, this patient decided to continue his search. He researched on the Internet and found a technique call Graston. That is what lead him to our clinic. Graston is a very effective soft tissue technique that utilizes stainless steel instruments to break up the scar tissue and adhesions that build up with injuries such as this. He was sure this would cure him so he came in looking for the miracle pill and he was sure this was it.

On evaluation day, we informed him there is no miracle pill. Graston is fantastic but it is not your solution. Actually, it is not the only solution. The truth is everything he did along the way was correct. He needed manipulation of his SI joint as the restrictions in his low back were creating an abnormal gait, just as his chiropractor said. He also needed the orthotics. He was ovepronating and it was causing extreme stress on his fascia (this is why every time he went back to running the pain returned).

“Well the orthotics made it worse,” the ultra-marathoner shared. That is because of the adhesions and scar tissue that has built up over time. This is where the Graston will come in. It also needs to be applied to the calf, quad and low back as there are many muscular imbalances either as a result of this journey or one of the original causes.

We made all the corrections and treated him up to the race. We are happy to report the ultra-marathoner finished the 50 miles virtually pain free!

Important Takeaways

The moral of this ultra-marathoner’s story is two-fold:

• First, pain is usually not where the problem is.
• Secondly, the whole lower kinetic chain must be addressed when dealing with any runners injury.

This is why we have a multi-discipline clinic that combines the benefits of chiropractic, physical therapy, strength and conditioning for any injury. For additional information on Plantar Fascitis or the lower Kinetic Chain, view our article entitled Plantar Fascitis & Other Lower Leg Injuries or email us with any questions or comments.