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Eat When You’re Hungry…
And stop when you’re full. I’m not a big fan of giving unsolicited nutritional advice. So this blog is not going to have anything to do with food or nutrition. What I would like to discuss is medical necessity and maintenance care.
Most third-party payers (insurance companies and benefit administration groups) will not include maintenance care as a covered benefit. Maintenance care is defined as treatment meant to keep you at your current health level. What they expect from doctors is to treat you for a specific problem and work toward a specific goal, namely, improving your current health status. Headaches are a great way to illustrate this idea. Let’s say you have a headache and you come into the office for treatment. As a result of the treatment, the headache lessens in either intensity or frequency over the course of five visits. All five of these treatments are medically necessary. One week later, you schedule an appointment and you have not had a headache since your last visit. Your goal is to keep the headaches from returning. This visit is considered maintenance care and would not be covered by your insurance company. However, if you have had two less-intense headaches during that same week, but do not currently have one on the day of your visit, we are still treating your headaches, and therefore your visit is medically necessary.
This can be confusing—in both scenarios, you come into the office for treatment and you are not currently in pain. The difference is whether or not you have reached your treatment goal of relieving pain due to headaches. This type of health care actually makes a lot of sense. Treat the problem until the problem is gone and when it’s gone, stop treatment and enjoy your life. Eat when you’re hungry…and stop when you’re full.
Of Timing Belts and Trigger Points
Many of you know that I’m a big car guy. I am particularly fond of (obsessed with) Toyota Land Cruisers, but I also drive a 1990 Honda Accord. The 4-cylinder engine in my Honda is what they call a “zero-tolerance engine.” This means that when a piston reaches top-dead-center it is actually in the same space that the valve was in when the valve was open. The only thing keeping the piston from hitting the valve is the timing belt. Replacing the timing belt costs $300-400. If the regular maintenance schedule is ignored and the timing belt wears out, the piston will hit the valve and a new engine is necessary. Replacing the engine costs $2000-3000.
So what does that have to do with trigger points? Trigger points have both latent and active phases. Latent trigger points are not painful unless direct pressure is applied to the trigger point. Active trigger points are painful without any pressure at all. After an hour of myotherapy, we hear many of our patients say “I had no idea I was that sore.” What this says to us is, “I had no idea I had so many latent trigger points.” Generally, it is easier to treat latent trigger points than it is to treat active trigger points. The same is true with treating injuries. It is much easier to treat minor injuries in the first 72 hours than it is to treat an injury that is more than two weeks old. There was a study in the peer-reviewed journal Spine (25 (14), 1782-7) which found that nearly 90% of whiplash patients that received early, active treatment were pain-free six months after the injury. Only 15%, however, were pain-free at six months following standard treatment protocols.
With our “zero-tolerance lives,” where we place so many demands on our bodies, it is much more cost-effective to treat trigger points and injuries when they are new. If you consider the number of visits, pain and suffering, and possible time off work, it just makes sense to seek treatment early and regularly to keep our bodies performing at optimal levels.
After an injury, what medicine should I take?
This is a very important question, but not one a lot of people probably think much about. Most people likely think “What do I have that is close and will take the pain away?”
In a previous post I said “There is no healing without inflammation!” Inflammation is your body’s response to an injury. Damaged cells release chemical messengers that start the inflammatory process. Many over-the-counter pain medicines are also anti-inflammatory in nature. If you interrupt this process it can slow, or even stop the inflammatory process that is vital to the healing process. Ibuprofen, and naproxen are both anti-inflammatory, as well as being analgesic (pain killers). Of the common over-the-counter pain medicines, only ACETAMINOPHEN is not anti-inflammatory and will allow the healing to take place. If you need something stronger, a visit to your family doctor can usually put you into a narcotic that is a far better pain killer, and is also not anti-inflammatory.
Ice vs. Heat?
This is a common one that comes up in our office all the time. There are a couple questions that you have to ask, but as a general rule ice is better than heat. Ice reduces inflammation which is generally responsible for the sharp pain you may be experiencing. Many times we use ice to aid the healing process. There is no healing without inflammation! The problem is that inflammation is not very efficient on its own, it tends to all rush in and try to fix the problem all at once, creating a gridlock-like situation in your blood vessels. Ice closes down the blood vessels, squeezing the inflammatory cells and blood products out of the area. This allows new, fresh blood products and cells to come in and heal the injured area. In this type of icing, the number of cycles that you have the ice on and off is critical to how well the ice works. The more cycles you can ice, the better, and faster, the area will heal. Think of it as wringing the soap out of a sponge. The soap never really gets rinsed away if you simply run water over the sponge, but if you squeeze the sponge you can clear the soap very quickly.
Heat is appropriate in some situations. It is generally easy to tell when to heat by the type of pain you are having. Sharp or stabbing pain should always be iced, dull or achy pain that does not have any kind of sharp component (like with certain movements) can be heated. This type of pain is very common after a good workout, but wait about 24 hours after the workout to make sure there is no sharp pain which would indicate an injury. It is also appropriate to heat an area after an injury as long as ALL of the sharp pain has passed. Heat will allow the blood vessels to expand, which will clear any lactic acid built up in well worked muscles. It will also make the muscles, tendons, and ligaments more flexible which will relieve a lot of stiffness. Stretching after heating is a great way to increase flexibility without risking additional injury to the soft tissues. A hot tub is one of the best ways to heat an area, but if one is not available a long, hot bath will do just fine. Even a long shower can be a very beneficial method of heating an area. A dry heating pad placed over an area is the least effective method of heating. Without the moisture the heat never really penetrates the skin to get to the muscles below. Some heating pads come with a wettable cover to supply moist heat, but I am not a big fan of mixing water and electricity.
I hope this has been educational for you. As a reward for reading this post tell us the secret password: CHATTANOOGA for $5 off of one of our high quality ice packs that we have for sale in the office.
Why Do We Combine Chiropractic and Myotherapy?
I have often been asked, “What caused my pain? Did the tight muscle pull the joint out of place, or did the joint being out of place cause the muscle to become tight?” And the simple answer is YES. Nearly all of the joints in our bodies have muscle groups that cross those joints. In fact, they share a very “chicken and the egg” relationship. It is nearly impossible to tell which came first, or which one started the pain. I usually reply to this type of question “I don’t know what caused the pain, but I do know how to fix it.” By combining myotherapy with chiropractic care we can affect both the joint and the muscle at the same time.
For example, in an automobile collision ligaments and joint capsules can be torn or otherwise damaged, while at the same time muscles and tendons that cross that same joint can likewise be torn or damaged. It would be ineffective to treat only the joint damage or only the muscle damage.
For neck and headache issues we can even do the adjustments before getting off of the myotherapy table. This technique does not give the dozens of muscles in your neck the chance to tighten or react to a painful joint before an adjustment. I can also use much less force to accomplish the same adjustment because I do not have to compete with tight musculature.
There is another phenomenon that suggests why we should combine chiropractic adjustments with myotherapy, and that is what we call muscle memory. Whenever there is pain in the body (like from a restricted or injured joint), the natural reaction of the body is to tighten the muscles around the pain in a process called “splinting.” If that splinting is allowed to stay, even for periods as short as 24 hours, the muscle starts gearing up for staying in that position for “the long haul.” This can cause chronically tight muscles or muscle memory. Even if we were to adjust the damaged joint and restore proper joint motion, this muscle memory will often pull the joint back to it’s previous position, because that is where the muscles are “used” to being. If we first lengthen and relax the muscles they are less likely to return to their previous position after the adjustment, and therefore more likely to allow proper joint mobility.
What is Myotherapy?
Myotherapy is a term that literally means muscle therapy. We use the term myotherapy to differentiate our services from those that one would find at a typical spa or resort. While we can do spa-type services, we have chosen to focus on therapeutic techniques to effectively treat muscle pain or soft tissue injuries. These therapies include trigger point therapy, myofascial release, deep tissue, and sports massage. We can also employ active and passive stretching, and hot and cold therapies into each individual treatment plan. There is some good that can come from simply relaxing for an hour, but we believe that these therapies are far more effective at changing the structure and function of the muscular system than simply “spreading lotion around.”