Hello everyone. My name is Sarah and I am a Chiropractic Assistant (CA) in our Christiansburg's office. Dr. Matthis had asked me if I would like to write about some of the challenges I face as a CA and how to overcome these challenges.

Something I am very passionate about is archery. I have only been shooting for a short time, about 3-4 years, but in this time I have found that I'm actually pretty good with a bow. Archery, being a CA and working in a chiropractic office may sound like they would have nothing in common but they are actually quite alike. There are many different aspects of a bow and each part is needed in order to shoot successfully. I always want to make the best shot I can and in order for me to do that each part of my bow needs to be working correctly. The same is true of our office, each of us have different tasks that we perform day to day in order to give our patient the highest quality care and the greatest over all experience possible.

This past weekend I went to an archery tournament. I was having some trouble getting my arrow to hit the target in the right spot. This was getting very frustrating. I couldn't figure out why it wasn't working. I thought that maybe something was messed up with my bow. I had to check each part of my bow. I checked the sights, the string, the rest, all these different parts of my bow. After I made sure everything was ok with my bow, I still couldn't figure out what was wrong. I had ask another archer for help. I had him watch me shoot. I wanted him to help me rule out the possibility that I was doing something to make my arrow fly wrong. After he watched me, he said that he thought I was doing everything just right. But that still didn't solve my problem. We had to step out of the tournament action for a minute and start making some changes. We had to get out the range finder, this tells you how many yards the target is away from you. After checking the distance and shooting again, it turns out that my sights were not set correctly. After we reset my sight I was back to making great shots.

Just like with archery, being a CA can have its challenges too. Sometimes it isn't always clear what the problems are or how to fix them. One thing I have to do, as I did in the archery tournament, is check the basics. I do my own self-evaluation first. If that doesn't work then I have to ask for help and see if maybe someone else can tell me what I need to change or do differently in order to make things work better. Sometimes it’s hard to ask for help but that is how we all grow and become better at what we do. Whether my goal is to hit a target with an arrow or to hit our collections goals, I need to be at my best and to be at my best I need feedback from others.

So if you ever have questions about what you are doing, just ask someone. Bounce ideas off of each other, you'll learn something new!

I recently had a lady join our practice who was pregnant.  She became a patient because her baby was in the breech position (head up in the womb) and she heard I could help.  This patient  was aware that my daughter had also been breech during my wife’s pregnancy and that a chiropractic technique had greatly aided in her “turning” prior to labor.

We were taught in chiropractic school that a breech position in late gestation is often due to an intra-uterine constraint.  These are often caused by improper tension on the uterine ligaments due to a misaligned pelvis.  A technique is also taught in our pediatrics curriculum known as Webster’s Technique, named after its inventor, Dr. Larry Webster (http://icpa4kids.com/about/webster_technique.htm).  This technique addresses the improper pelvic alignment as well as the ligamentous constraint.  The correction of both problems allows for freer fetal movement, often resulting in the baby moving itself into the proper head-down position for labor and delivery.

After the history and evaluation, we began working with our “mother-to-be” using the analysis and adjustments as needed.  She reported, after several visits, a great increase in the baby’s movement after she received an adjustment.  She also reported sleeping better and a strange disappearance of her headaches! And after roughly six visits, she came in smiling and said, “Dr. Matthis, this baby is head down!!”

There was a great joy in my office that day.  A patient was impacted in a way that would allow her to continue in her pregnancy with one fewer stress.  Mother and baby will now be able to experience birth, a natural process, with one less intervention.  While, my wife and I eventually had to seek other professional interventions to aid in our daughter’s turning (Thank you, Dr. Roberts!!), I was able to help this patient avoid an unnecessary visit to the delivery ward prior to her labor.

The first Chiropractic adjustment was given in 1895 by D.D. Palmer. Chiropractic care has been achieving tremendous results with patient care.  Unfortunately until recent years Chiropractors have only been able to theorize why so many patients improved with their care.

Initially, Chiropractors stated that when a bone of the spine or vertebrae misaligned it put abnormal amounts of pressure on the nerve that it was designed to protect.  Essentially a hard bone was pinching a soft nerve.  That pressure prevented the nerve from working properly and thus caused symptoms or dis-ease in the body.  (Yes, I did mean dis-ease meaning the body is not at ease.)  The theory was later proved to be accurate when it was discovered that it only took the weight of a dime to alter the function of that nerve.  Thus, when a Chiropractor would deliver an adjustment, they would reduce the pressure on the nerve and the body would begin to heal.

Next, Chiropractors theorized that spinal joints could move out of position and scar tissue would develop around the joints thereby attracting fluid (swelling) and again would pressure the nerve.  This pressure would generally account for pain and immobility and is one of the main reasons why people visit a chiropractor today.  When a Chiropractic adjustment was delivered it would reduce the swelling, improve the mobility of the joint and decrease the pressure on the nerve.  Again, the body would begin to heal. 

Today, new research demonstrates how the loss of the central nervous system's ability to adapt to changes in your environment and recover has become the critical issue in achieving wellness and staying healthy.  The role of Chiropractic in improving the function of the central nervous system is the key to the benefits of care.  A series of EEG’s, which are specialized test that measure brain waves, demonstrated how a Chiropractic adjustment can alter the nature of the brain wave and allow the nervous system to essentially “restart.”  These new findings explain why Chiropractic care is so effective in helping patients that present with a range of symptoms from headaches/migraines to ear aches and indigestion. 

With the amounts of snow that have fallen this winter, you would be hard pressed to find anyone who has not had to shovel at least a little bit.  Most of the folks who have donned the snow boots and grabbed the shovel haven’t done so in quite some time and are most likely prove to injury. 

My office has had a theme of snow-shoveling-related injuries that may have been avoided.  Here are some tips to make sure you don’t join the masses and by keeping your spine safe.    

1- Wait until the snow quits falling-  This seems like a very common-sensical statement, but if there is snow in the driveway, you are not required to leave the house, and more is on the way, then leave it.  Let the neighbors think you are untidy because you’ll have enough energy left and be pain-free enough to help them clear their drive later.

2- Hydrate well-  In winter months our bodies require just as much water to function well as they do in the heat of the summer, but our thirst often isn’t as high.  Make sure your muscles are hydrated well to avoid possible injury.

3- Stretch-  Warm up prior to getting outside by doing some light stretching exercises.  This may seem silly, but certainly not as silly as lying in the yard in pain because you failed to take this simple step.

4- Take breaks-  All that snow fell over several days, so what makes us think we should clear it all in an hour?  Work in 20-30 time periods with “water breaks” in between.  Section the area to be cleared into smaller plots and clear one at a time.

These are a few suggestions that will help to avoid injury during the Winter Wonderland.  For more information on safe shoveling tips, visit this local article: http://www.roanoke.com/news/nrv/wb/235601%20

I am often told during a consultation that a symptom or complaint “just appeared” or “I did like I always have” and it “just started.”  These statements point out how suddenly symptoms may appear, but after a thorough history, examination, and explanation of my findings the patient realizes, as I did, during my fact finding session, these problems have been around for a while and have “reared their head.”

You see, the body has a wonderful way of compensating for minor bumps and bruises that allows it to continue functioning as optimally as possible.  Over time these bumps and bruises add up and the body begins to adapt less and less and the injuries are expressed, seemingly out of the blue, as symptoms/ pain.   This process can take days, month, years, and even decades to lead to pain that leads a person in my door.

The healing time for persistent problems is often proportionate to the amount of time the injury has been present and increases if the problems have been ignored after their initial occurrence.  For these reasons, we suggest treatment specifically designed for individual patients and their needs with the attempt to get rid of not only the painful symptoms that brought them to our office, but to get rid of the cause of those symptoms as well!

If you have ever heard the term “ergonomics” you may have taken some initiative to improve your desk at work.  What you may not know is that you are actually improving your overall health as well.

Ergonomics literally means the “laws of work.”  This term refers to “creating an environment where the equipment is made to fit the person and not forcing the person to fit the equipment.”  A great example would be a car seat.  Would you purchase a car where your head hits the roof and your knees straddle the steering wheel?  Obviously you wouldn't!  So why would you sit in a desk chair that forces you to lean into the desk for support, bend your knees at an odd angle and put direct pressure on your wrists when you type? 

Simple and cost effective strategies can be put into place to improve your posture, pain and symptoms.  Just 'google' the word office ergonomics and you will be immediately overwhelmed by the amount of helpful suggestions that are available to you.  You could also follow these simple suggestions and find yourself more comfortable at work immediately.

Place the top of your monitor at a height that is at your eye level.  For most of you, this means lifting your monitor 6 inches or more.

1. Place all your commonly needed items within arms reach.  Your phone, printer, stapler and document holder should be with 2 feet of your hands.  Reaching over and over will eventually put abnormal tension on your shoulders and neck.
2. Adjust the height of your chair so that you knees can bend at 90 degrees. 
3. Once every 30 minutes, leave your workstation for 5 minutes.  Once every hour leave your workstation for 10 minutes.  Essentially, for every hour that you are working, spend 15 minutes moving around.  Time your restroom breaks or grabbing a paper off of the printer.
4. Finally, if after only a few hours at your workstation you are developing headaches, mid back pain or numbness in your hands, LISTEN TO YOUR BODY!  Something is not working right. Get advice or help. 

Our office is available to answer your questions.  If you know your fellow employees are in need of help, we are able to present this information at your work.  Ask the doctor for more information.

One of the holy grails of pain research is finding a solid predictor of which patients will have a single episode of low back pain and which patients will develop chronic lower back pain and/or disability after their initial low back injury.  Many research studies are done and millions of dollars are spent each year in this pursuit.  Just about every characteristic (height, weight, age, gender, etc) has been studied along with any other aspect of the chronic pain sufferer’s life to decide the predictive value of certain aspects of a patient’s case.

What do you think the most predictive characteristic for low back pain chronicity and future disability is?  Obesity?  Prior back surgery?  Type of injury?

What would you say if I told you that multiple studies have shown that the most predictive factor for progression of low back pain from acute to chronic are psychological factors¹ like depression, fear avoidance, and poor outlook?  Pretty cool huh?

How about if I told you that depression and other psychological factors were found to be more predictive than MRI findings²?  This means that your mental attitude about your pain is more important to your recovery than the findings of a highly advanced diagnostic test!

What does this mean to the average patient?  It means that a patient’s attitude about their injury or pain is very important to the outcome of the case.  Patients who tell me “I have been told I have a slipped disc and I just know it will never get back to 100%” are likely prolonging their recovery simply by having those thoughts.  If the same patient says to me “OK, I hurt my back but I’m ready to do whatever it takes and I know we can get this thing resolved.” I am much more optimistic about the prognosis of the case.

Positive attitude and outlook about your health can go a long way toward a cure for what ails you.  One of our goals is to foster positive outlooks and design treatment plans to put you in the best place you can be following a bout of lower back (or neck, arm, leg, etc.) pain.  In the end though, it’s up to the patient and his/her attitude.  Thinking well can actually help you to get well!

1. The dominant role of psychosocial risk factors in the development of chronic low back pain disability.

2. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain.

If you have ever experienced the excruciating pain of sciatica or severe low back pain, you'll do anything to reduce the symptoms.  Often any type of pill, potion or lotion is no match for this disabling pain.  What you may not know is that your wallet could be the reason why you are in so much pain.

So how is the wallet causing all this pain?  Think of it like this, if you had a pebble in your shoe and constantly walked on it day in and day out, would your foot eventually begin to hurt?  Absolutely! Essentially that pebble is your wallet to the pelvic bones.  Every time you sit on your wallet you slightly elevate one side of your hip bones.  Although the pressure created is minimal at first, think about what 15, 20 or 25 years of the continuous pressure on one side of your gluteus!  That slight pressure is just enough to cause a chain reaction of problems with the joints, nerves, muscles and ligaments of your low back.  The ligaments will slightly stretch due to the presence of a wallet.  Next, the muscles will tighten and relax to accommodate that change.  Your body will innately cause inflammation and swelling around the joints and finally (over time) you will begin to pressure the nerves.  Once this happens; you know it.  Sciatica can be debilitating. 

Patients may go through months of physical therapy or even surgery to reverse the damage caused by their wallet, with still no relief.  A Chiropractor is the only health care professional able to reverse all the damages associated with the wallet.  Once you get the much needed care by a Chiropractor, I highly recommend purchasing a money clip and storing your goods in your front pocket.  Experts also say that this is a safer place to keep your valuables. 

I was recently out of the office attending to family business and had another doctor cover my schedule.  One particularly tough case that I had been working with received a different style adjustment than I had previously used with wonderful results.  That doctor and I consulted after the visit and I have changed my approach slightly to offer the patient the maximum effect of their care.

The majority of my patients have one doctor that they report to for certain issues they face; one PCP, one cardiologist, one optometrist.  While having one doctor familiar with your specific case and issues is often ideal, one doctor focusing on you does have its set-backs.  If you certain presentation does not fit in their “box” of thinking or area of expertise, the patient may receive less-than-optimal care.           

Most health care practitioners are unable or unwilling to consult with other professionals in their arena due to lack of option or fear of “losing” their patient.  I think the real losers in these situations are the patients.

By having doctors working in a company with multiple approaches to patient care, offering numerous viewpoints with case management, it leads to better results for patients. 

Estimates of 75%-97% of Americans are “chronically dehydrated.”  So does this mean that Eight 8-ounces of H20 isn't enough?  Well-Yes! (unless you weigh 128 lbs and don't exercise-I'll explain later.)

So how much water do you need?  This is a daily conversation in my office.  We have always been taught that adequate water consumption is 64 ounces or eight 8-ounce glasses of water a day.  But even this seems like an astonishing amount of water to consume for some people.  So let's see how much water you need each day.

First, take your body weight and divide by 2 (or half your body weight).  This number represents the amount of water that you need in ounces.  Let me show you an example.  Take an individual who weights 180 lbs.  That person would need 90 ounces of water daily.  DAILY?  Yes, daily! 

At first consuming this amount of water will force you to use the restroom 5-10 times a day. But don't worry, your bladder is partially muscle and will be trained to hold larger amounts of fluid without sending the signal to race to the nearest restroom. 

The best way I have found to track my daily progress is to do the calculation of needed water daily and fill a jug of water with that amount.  Each day drink from that container and monitor your intake.  The first week or so, it may be difficult.  But believe me every cell in your body will benefit from this added hydration. 

Do you need to consume an additional amount of water when exercising? Yes-you do and the amount of water is dependent on the type and intensity of exercise.  Generally the water that you sweat will need to be replaced and so monitor your exercise accordingly. 

As for the rest of the story:

I prefer drinking spring or filtered water over tap/bottled water.  Next, if you have a glass container, use it.  Glass has been shown to be the least toxic for long term storage of fluids.  Room temperature water will be better than hot or cold fluids.  Drinking higher quantities may improve your metabolism.  I also don't recommend drinking fluoridated water even if your feeding it to a toddler.

Every day I engage with a patient about “pillow talk.”  When you consider the importance of how you spend 1/3 of your day, you can to see the relevance of this discussion.

First, the pillow must fit you!  Not the other way around.  Second, the pillow you choose will greatly differ from how you sleep.  Basically, what position do you sleep in, most of the night.  The damage that you cause to your neck from a poor or improperly fitted pillow will lead to problems with your spine.  A Chiropractor will be able to help you recover from the damage, but stopping the pressure on the nerves must be the first priority.

Here are the basics.  You need a pillow that is going to support a neutral posture the entire night.  No other decision about a pillow will be as important as how it supports your neck and shoulders.  Secondary considerations are allergies to the material and hygiene.  Because of the oils in your hair and face, you should replace your pillow once every four to six months.  Dust mites and bacteria will build up in almost any material and lead to allergies and poor skin.  The oils will also flatten the pillow, changing how it supports you.

If you are a back sleeper, you will need a single pillow with a slight curve in it.  This will support your spine while keeping your alignment neutral.  Too small of a pillow will stress the lower part of your neck and too many or too large of a pillow will place excess stress on the upper part of your neck.  Neither of which is conducive to a good nights rest.  An excellent cervical curve pillow may be available from your Chiropractor.

Stomach sleepers, though not recommended, need a very thin pillow that will offer more cushion than support.  A thin pillow will prevent excess pressure on the face and shoulders and again promote healthy alignment of your spine. 

Finally, the side sleepers are the trickiest to figure out.  They need a pillow that is going to fill the space between the side of the shoulder/arm and the neck.  A pillow too small or too large with cause the neck to rest at an odd angle and will lead to AM stiffness and pain in the shoulder muscles.  I recommend choosing a pillow at the store and keep the costs low ($4-$6), try the pillow out for several nights.  If the pillow works well, go back to the store and invest in two or three more pillows of the exact brand and size.  Then, replace the pillow once every four to six months to prevent thinning of the pillow due to oils from your skin.

Once you have found a pillow that fits you, always come back to the same pillow.  If for any reason the pillow no longer supports you, start the process over and find the right pillow for your body.  Again, 1/3 of your life is spent sleeping.  Isn’t it worth the investment of time, effort, and money to find the right pillow?

If I have heard it once, I have heard it a thousand times; “How could I be in this pain when all I have done is sit?”

Can sitting really cause pain?

The answer, as I am sure you can figure out by my tone, is…YES!

The main questions are, “Why does sitting cause pain?” and “How can I keep from getting pain from sitting?”

Pain can result from your spine being in a position that is not consistent with its normal posture. Spines have two concave curves and two convex curves.

When you put your spine outside of these normal curves, over time micro injuries can result.  These micro injuries progress to a major injury over time…a.k.a. PAIN!!

Therefore, to prevent these injuries from occurring, you should attempt to keep your spine in these normal postures as much as possible.

For healthier sitting, we have adapted these suggestions from the American Chiropractic Association: 

• Sit in a chair such that the curve in back of chair hits your back around your belt line
• Keep your shoulders “rolled back” rather than slumped forward
• Put your feet flat on floor with your thighs parallel to the floor

For a quick self-evaluation check this link out. If you want to create a real pain in my life, put me in a chair without lumbar support!

When a patient presents in our office, it is not uncommon for them to be in severe pain. I often get asked “what can I do for this pain?”

Though there are many drugs, over-the-counter drugs, and herbs  for pain that can be used, I have found that ice packs are the most beneficial home remedy for short-term relief.

When you have an injury, your body's first response is to swell. It is also known as “inflammation.” When you place a cold pack on the injured area, it reduces the blood flow to that area and therefore reduces the swelling. Most doctors understand this process and commonly prescribe anti-inflammatory medications (also know as NSAIDS)  

Therefore, we often recommend ice in the beginning part of a patient's care plan. If the other anti-inflammatories are used, that is fine as long as you're addressing the primary injury. 

If you've just been injured we recommend placing ice on the area as soon as possible. This will prevent inflammation from setting in, lessen your healing time and lessen the time it takes to get relief.

Research finally indicates that watching too much TV is linked to obesity.  A recent article published in the Journal of Medicine & Science in Sports & Exercise found that increased TV has lowered muscular fitness.  http://journals.lww.com/acsm-msse/Abstract/2009/11000/Muscular_Fitness_in_Relation_to_Physical_Activity.4.aspx

Did we really need research to tell us this? It has been discussed many times.  http://www.aafp.org/afp/20011001/tips/3.html

I was a “fat boy” as a kid.  I had very busy parents who worked hard to provide for our family.  However, I had very few examples of how to use my time wisely.  I watched at least 15-20 hours of TV per week.  I ate poorly.  I was big, but I felt small.  And my self-esteem was tinier than that.  It wasn’t that my parents didn’t love me.  I think it was just the lifestyle I evolved into as a result of my surroundings.  

I was in my mid-30s before I took personal responsibility to lose the weight and change my lifestyle.

Therefore, I ask, no, I bet you - let’s use common sense with our children.  Let’s provide our kids with other activities (whether in our school systems or at home).  Let’s look at how our kids are spending their time and what they are eating.  We all know fruit is a better snack than a Little Debbie cake (my snack of choice as a kid)!

Some helpful hints for keeping children active and reducing the amount of TV they watch include:

http://www.ucsfchildrenshospital.org/education/exercise_tips/index.html

http://weightloss.suite101.com/article.cfm/obesity_and_children

http://www.awarefoundation.org/parents/articles/obesity_tips.aspx

http://www.trashyourtv.com/gooutside

Let’s do it!  We, one at a time and all together, can make a difference in our homes and in our communities.

For over 30 years, at Tuck Chiropractic we have treated literally thousands of patients.  Most assume patients who consult a chiropractor to be very active people such as construction workers or athletes.  However, these patients make up a very small percent of our practice.  Across America, 40-50% of people are suffering from chronic back pain. 

The chronic pain patients we see have injuries commonly known as cumulative type traumas.  http://www.eorthopod.com/public/patient_education/6603/cumulative_trauma_disorder.html

These would be defined as small injuries, accumulating over time, into a major injury.  To explain this to patients, I use this example:  If you were to walk on the side of your foot all the time, eventually you will sprain your ankle. 

If you are in pain, these are important questions to answer:

Is my pain new or reoccurring?

If you have never had this pain before and you can attribute it to a specific injury or activity, there is a possibility that no care is needed.  Our suggestion is to apply ice to the area of pain for periods no longer than 20 minutes.  http://www.tuckclinic.com/content/general/injured.vesh.  If the pain does not subside, seek professional advice.  If it is a reoccurring type pain, you could be developing a chronic pain condition.  It is best to address this immediately.  We find some of our patients are developing degenerative joint disease, an irreversible condition.  http://www.ecureme.com/emyhealth/data/Degenerative_Joint_Disease.asp

What if I cannot attribute my pain to a specific event?

Do you engage in activity regularly (perhaps working at a computer or working on a factory line)?  This activity, over time, creates the same result as a single trauma.  If this is the situation, a “two-pronged” approach usually is necessary.  First you must address the injury to get it to heal.  Second, you must look at your activities and do what is called an ergonomic analysis.

No matter what the cause of your pain, you do not have to live with it.  Pain is a signal in your body that something is wrong and should be corrected.  Some of our patients explain pain away as a sign of old age.  Whether you are 17 or 97 there are things that can be done to relieve your pain and get you back to living your life to the fullest.